- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $263.03
| Facility | 26 | $63.10 | $91.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $707.95
| Professional | | $204.17 | $302.00 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $154.88
| Professional | 26 | $51.29 | $74.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $537.03
| Professional | TC | $147.91 | $213.80 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $234.42 / $645.65
| Professional | | $181.97 | $234.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $141.25
| Professional | 26 | $50.12 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $169.82 / $478.63
| Professional | TC | $131.83 | $169.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $245.47 / $331.13
| Professional | | $89.13 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $69.18 / $100.00
| Facility | 26 | $14.79 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $512.86 / $2,187.76
| Professional | | $177.83 | $512.86 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $95.50 / $263.03
| Professional | 26 | $44.67 | $95.50 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $380.19 / $1,995.26
| Professional | TC | $128.82 | $380.19 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $478.63
| Professional | | $229.09 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $128.82
| Professional | 26 | $60.26 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $354.81
| Professional | TC | $165.96 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $446.68
| Professional | | $204.17 | $331.13 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $89.13 / $123.03
| Professional | 26 | $39.81 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $354.81
| Professional | TC | $144.54 | $257.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $446.68
| Professional | | $269.15 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $89.13 / $125.89
| Professional | 26 | $72.44 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $323.59
| Professional | TC | $194.98 | $229.09 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $812.83
| Professional | | $190.55 | $309.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $213.80
| Professional | 26 | $50.12 | $79.43 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $223.87 / $616.60
| Professional | TC | $141.25 | $223.87 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $66.07 / $169.82
| Facility | 26 | $50.12 | $66.07 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $630.96
| Professional | | $204.17 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $154.88
| Professional | 26 | $50.12 | $89.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $257.04 / $457.09
| Professional | TC | $144.54 | $257.04 | $457.09 |