- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $257.04
| Facility | 26 | $95.50 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $676.08
| Professional | | $199.53 | $338.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $190.55
| Professional | 26 | $54.95 | $85.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $467.74
| Professional | TC | $144.54 | $245.47 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $95.50
| Facility | 26 | $14.45 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $707.95
| Professional | | $208.93 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $91.20 / $177.83
| Professional | 26 | $58.88 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $537.03
| Professional | TC | $151.36 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $446.68 / $537.03
| Professional | | $389.05 | $446.68 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $125.89 / $151.36
| Professional | 26 | $109.65 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $316.23 / $389.05
| Professional | TC | $275.42 | $316.23 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $173.78
| Facility | 26 | $85.11 | $128.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $691.83
| Professional | | $323.59 | $457.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $181.97
| Professional | 26 | $77.62 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $549.54
| Professional | TC | $229.09 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $407.38
| Professional | | $100.00 | $154.88 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $478.63 / $676.08
| Professional | | $218.78 | $478.63 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $173.78
| Professional | 26 | $58.88 | $128.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $371.54 / $588.84
| Professional | TC | $151.36 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | 26 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $630.96
| Professional | | $380.19 | $489.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $169.82
| Professional | 26 | $107.15 | $134.90 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $457.09
| Professional | TC | $269.15 | $346.74 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $707.95
| Professional | | $199.53 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $186.21
| Professional | 26 | $56.23 | $85.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $275.42 / $512.86
| Professional | TC | $141.25 | $275.42 | $512.86 |