- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $97.72 / $489.78
| Facility | 26 | $54.95 | $97.72 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $812.83
| Professional | | $275.42 | $398.11 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $257.04
| Professional | 26 | $77.62 | $93.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $288.40 / $660.69
| Professional | TC | $213.80 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $562.34
| Professional | | $245.47 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $144.54
| Professional | 26 | $64.57 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $380.19
| Professional | TC | $158.49 | $199.53 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $691.83
| Professional | | $208.93 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $138.04 / $218.78
| Professional | 26 | $85.11 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $562.34
| Professional | TC | $208.93 | $338.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | 26 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $707.95
| Professional | | $269.15 | $416.87 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $204.17
| Professional | 26 | $74.13 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $489.78
| Professional | TC | $190.55 | $302.00 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 26 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,570.40 / $2,570.40
| Professional | | $2,089.30 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $691.83
| Professional | 26 | $549.54 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Professional | TC | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $371.54 / $645.65
| Professional | | $302.00 | $371.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $186.21
| Professional | 26 | $83.18 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $446.68
| Professional | TC | $208.93 | $263.03 | $446.68 |