- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $602.56
| Facility | 26 | $91.20 | $154.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $602.56
| Professional | | $257.04 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $173.78
| Professional | 26 | $81.28 | $97.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $239.88 / $446.68
| Professional | TC | $186.21 | $239.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $645.65
| Professional | | $338.84 | $501.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $234.42
| Professional | 26 | $100.00 | $147.91 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $457.09
| Professional | TC | $245.47 | $331.13 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $398.11 / $3,890.45
| Professional | | $169.82 | $398.11 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $141.25
| Professional | 26 | $100.00 | $112.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $323.59 / $436.52
| Professional | TC | $257.04 | $323.59 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $707.95
| Professional | | $295.12 | $436.52 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $208.93
| Professional | 26 | $83.18 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $302.00 / $489.78
| Professional | TC | $208.93 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $512.86
| Professional | | $346.74 | $467.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $141.25
| Professional | 26 | $100.00 | $134.90 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $363.08
| Professional | TC | $251.19 | $331.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Professional | 26 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $363.08 / $3,715.35
| Professional | | $125.89 | $363.08 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $245.47
| Professional | 26 | $100.00 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $302.00 / $549.54
| Professional | TC | $218.78 | $302.00 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $407.38 / $691.83
| Professional | | $269.15 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $208.93
| Professional | 26 | $85.11 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $478.63
| Professional | TC | $186.21 | $281.84 | $478.63 |