- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $173.78
| Facility | 26 | $141.25 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $426.58
| Professional | | $89.13 | $165.96 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $147.91
| Professional | 26 | $33.11 | $56.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $239.88
| Professional | TC | $56.23 | $89.13 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $346.74
| Professional | | $93.33 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $141.25
| Professional | 26 | $44.67 | $67.61 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $109.65 / $218.78
| Professional | TC | $50.12 | $109.65 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $380.19
| Facility | 26 | $131.83 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $316.23 / $489.78
| Professional | | $123.03 | $316.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $123.03 / $204.17
| Professional | 26 | $47.86 | $123.03 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $281.84
| Professional | TC | $79.43 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $457.09 / $660.69
| Professional | | $446.68 | $457.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $173.78 / $251.19
| Professional | 26 | $154.88 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $288.40 / $407.38
| Professional | TC | $263.03 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $208.93 / $338.84
| Professional | | $107.15 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $58.88 / $147.91
| Professional | 26 | $38.90 | $58.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $218.78
| Professional | TC | $63.10 | $95.50 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $281.84 / $588.84
| Professional | | $100.00 | $281.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $120.23 / $239.88
| Professional | 26 | $42.66 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $162.18 / $331.13
| Professional | TC | $69.18 | $162.18 | $331.13 |