- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $218.78
| Facility | 26 | $74.13 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $426.58 / $812.83
| Professional | | $323.59 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $85.11 / $208.93
| Professional | 26 | $67.61 | $85.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $630.96
| Professional | TC | $263.03 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $100.00
| Professional | 26 | $52.48 | $93.33 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $331.13 / $851.14
| Professional | | $91.20 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $549.54 / $776.25
| Professional | | $331.13 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $162.18
| Professional | 26 | $64.57 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $446.68 / $691.83
| Professional | TC | $263.03 | $446.68 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $588.84 / $2,187.76
| Professional | | $346.74 | $588.84 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $380.19
| Professional | 26 | $72.44 | $104.71 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $1,230.27
| Professional | TC | $309.03 | $446.68 | $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
- $457.09 / $467.74 / $501.19
| Professional | | $457.09 | $467.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $95.50
| Professional | 26 | $81.28 | $89.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $363.08 / $407.38
| Professional | TC | $346.74 | $363.08 | $407.38 |
- 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
- $389.05 / $524.81 / $851.14
| Professional | | $389.05 | $524.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $151.36
| Professional | 26 | $74.13 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $407.38 / $691.83
| Professional | TC | $309.03 | $407.38 | $691.83 |