- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $79.43 / $102.33
| Facility | 26 | $58.88 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $239.88 / $691.83
| Professional | | $107.15 | $239.88 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $123.03
| Professional | 26 | $44.67 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $295.12
| Professional | TC | $95.50 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $363.08
| Professional | | $123.03 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $109.65
| Professional | 26 | $48.98 | $89.13 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $239.88
| Professional | TC | $204.17 | $204.17 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $288.40 / $302.00
| Professional | | $275.42 | $288.40 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $87.10 / $91.20
| Professional | 26 | $83.18 | $87.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $204.17 / $213.80
| Professional | TC | $190.55 | $204.17 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | 26 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $338.84 / $478.63
| Professional | | $123.03 | $338.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $138.04
| Professional | 26 | $54.95 | $107.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $239.88 / $338.84
| Professional | TC | $117.49 | $239.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Facility | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $457.09
| Professional | | $190.55 | $281.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $87.10 / $120.23
| Professional | 26 | $58.88 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $724.44
| Professional | TC | $131.83 | $181.97 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $338.84 / $537.03
| Professional | | $302.00 | $338.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $104.71 / $158.49
| Professional | 26 | $91.20 | $104.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $239.88 / $380.19
| Professional | TC | $208.93 | $239.88 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | 26 | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $537.03
| Professional | | $302.00 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $107.15 / $158.49
| Professional | 26 | $91.20 | $107.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $380.19
| Professional | TC | $208.93 | $245.47 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $114.82 / $269.15
| Professional | | $48.98 | $114.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $398.11
| Professional | | $190.55 | $257.04 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $123.03
| Professional | 26 | $56.23 | $83.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $269.15
| Professional | TC | $131.83 | $173.78 | $269.15 |