- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $229.09 / $501.19
| Facility | 26 | $85.11 | $229.09 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $2,137.96
| Professional | | $331.13 | $501.19 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $186.21 / $446.68
| Professional | 26 | $97.72 | $186.21 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $776.25
| Professional | TC | $218.78 | $338.84 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $288.40 / $457.09
| Professional | | $218.78 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $199.53
| Professional | 26 | $89.13 | $141.25 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | TC | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $575.44 / $1,445.44
| Professional | | $371.54 | $575.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $257.04
| Professional | 26 | $100.00 | $151.36 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $1,258.93
| Professional | TC | $263.03 | $407.38 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $407.38
| Professional | | $112.20 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $741.31 / $1,621.81
| Professional | | $316.23 | $741.31 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $295.12
| Professional | 26 | $97.72 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $501.19 / $1,148.15
| Professional | TC | $218.78 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $416.87 / $2,570.40
| Professional | | $323.59 | $416.87 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $389.05
| Professional | 26 | $107.15 | $144.54 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $281.84 / $2,089.30
| Professional | TC | $218.78 | $281.84 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $302.00 / $588.84
| Professional | | $112.20 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $602.56 / $1,348.96
| Professional | | $331.13 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $263.03
| Professional | 26 | $104.71 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $398.11 / $1,047.13
| Professional | TC | $223.87 | $398.11 | $1,047.13 |