- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $173.78 / $323.59
| Facility | 26 | $97.72 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $1,023.29
| Professional | | $346.74 | $467.74 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $354.81
| Professional | 26 | $91.20 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $575.44
| Professional | TC | $251.19 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $107.15 / $151.36
| Professional | 26 | $104.71 | $107.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $416.87 / $891.25
| Professional | | $131.83 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $562.34 / $851.14
| Professional | | $389.05 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $213.80
| Professional | 26 | $95.50 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $660.69
| Professional | TC | $288.40 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $707.95 / $1,949.84
| Professional | | $380.19 | $707.95 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $194.98 / $724.44
| Professional | 26 | $112.20 | $194.98 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $1,230.27
| Professional | TC | $288.40 | $416.87 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $489.78 / $524.81
| Professional | | $467.74 | $489.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $131.83 / $138.04
| Professional | 26 | $128.82 | $131.83 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $338.84 / $380.19
| Professional | TC | $323.59 | $338.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $812.83
| Professional | | $436.52 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $199.53
| Professional | 26 | $97.72 | $138.04 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $426.58 / $616.60
| Professional | TC | $331.13 | $426.58 | $616.60 |