- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $524.81
| Facility | 26 | $72.44 | $134.90 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $275.42 / $501.19
| Professional | | $218.78 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $239.88
| Professional | 26 | $70.79 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $309.03
| Professional | TC | $141.25 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $478.63
| Professional | | $223.87 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $165.96
| Professional | 26 | $75.86 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $199.53 / $309.03
| Professional | TC | $144.54 | $199.53 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $323.59 / $1,047.13
| Professional | | $114.82 | $323.59 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $107.15 / $162.18
| Professional | 26 | $95.50 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $218.78 / $275.42
| Professional | TC | $194.98 | $218.78 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | 26 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $524.81
| Professional | | $204.17 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $173.78
| Professional | 26 | $63.10 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $218.78 / $363.08
| Professional | TC | $134.90 | $218.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $346.74
| Professional | | $223.87 | $269.15 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $117.49
| Professional | 26 | $74.13 | $91.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $234.42
| Professional | TC | $147.91 | $177.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $416.87 / $602.56
| Professional | | $338.84 | $416.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $177.83
| Professional | 26 | $117.49 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $380.19
| Professional | | $263.03 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $295.12 / $1,230.27
| Professional | | $104.71 | $295.12 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $177.83
| Professional | 26 | $83.18 | $107.15 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $239.88 / $380.19
| Professional | TC | $162.18 | $239.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $537.03
| Professional | | $173.78 | $302.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $173.78
| Professional | 26 | $57.54 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $380.19
| Professional | TC | $123.03 | $213.80 | $380.19 |