- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $562.34
| Facility | 26 | $120.23 | $186.21 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $954.99
| Professional | | $275.42 | $426.58 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $239.88
| Professional | 26 | $81.28 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $562.34
| Professional | TC | $190.55 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $66.07
| Professional | 26 | $64.57 | $64.57 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $398.11 / $912.01
| Professional | | $288.40 | $398.11 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $169.82
| Professional | 26 | $85.11 | $104.71 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $741.31
| Professional | TC | $199.53 | $288.40 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $295.12 / $524.81
| Professional | | $275.42 | $295.12 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $89.13 / $123.03
| Professional | 26 | $87.10 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $416.87
| Professional | TC | $186.21 | $204.17 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $131.83
| Facility | 26 | $19.95 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $933.25
| Professional | | $245.47 | $467.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $204.17
| Professional | 26 | $70.79 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $758.58
| Professional | TC | $181.97 | $354.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $588.84 / $758.58 / $758.58
| Facility | 26 | $588.84 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $602.56 / $3,388.44
| Professional | | $302.00 | $602.56 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $660.69
| Professional | 26 | $77.62 | $123.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $457.09 / $2,951.21
| Professional | TC | $218.78 | $457.09 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $758.58
| Professional | | $281.84 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $218.78
| Professional | 26 | $77.62 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $616.60
| Professional | TC | $204.17 | $302.00 | $616.60 |