- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $549.54
| Facility | 26 | $77.62 | $141.25 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $380.19 / $1,548.82
| Professional | | $275.42 | $380.19 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $275.42
| Professional | 26 | $77.62 | $93.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $549.54
| Professional | TC | $204.17 | $269.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $676.08
| Professional | | $288.40 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $177.83
| Professional | 26 | $79.43 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $288.40 / $457.09
| Professional | TC | $213.80 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $3,235.94
| Professional | | $288.40 | $436.52 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $154.88
| Professional | 26 | $100.00 | $112.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $323.59 / $457.09
| Professional | TC | $288.40 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | 26 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $724.44
| Professional | | $257.04 | $426.58 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $190.55
| Professional | 26 | $66.07 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $524.81
| Professional | TC | $190.55 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $478.63
| Professional | | $295.12 | $354.81 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $123.03
| Professional | 26 | $77.62 | $95.50 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $354.81
| Professional | TC | $213.80 | $263.03 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $724.44
| Professional | | $489.78 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $169.82 / $186.21
| Professional | 26 | $134.90 | $169.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $524.81
| Professional | | $338.84 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $371.54 / $1,621.81
| Professional | | $109.65 | $371.54 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $173.78
| Professional | 26 | $87.10 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $537.03
| Professional | TC | $234.42 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $389.05 / $707.95
| Professional | | $213.80 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $186.21
| Professional | 26 | $64.57 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $281.84 / $501.19
| Professional | TC | $162.18 | $281.84 | $501.19 |