- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $181.97
| Facility | 26 | $79.43 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $416.87
| Professional | | $95.50 | $128.82 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $229.09
| Professional | 26 | $57.54 | $83.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $52.48 / $112.20
| Professional | TC | $28.18 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $141.25
| Professional | 26 | $120.23 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $218.78
| Professional | | $93.33 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $125.89
| Professional | 26 | $54.95 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $91.20
| Professional | TC | $40.74 | $66.07 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $199.53 / $251.19
| Professional | | $109.65 | $199.53 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $158.49
| Professional | 26 | $74.13 | $125.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $70.79 / $104.71
| Professional | TC | $30.90 | $70.79 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $281.84 / $281.84
| Facility | 26 | $141.25 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $870.96
| Professional | | $144.54 | $186.21 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $380.19
| Professional | 26 | $95.50 | $120.23 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $58.88 / $309.03
| Professional | TC | $41.69 | $58.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $199.53 / $257.04
| Professional | | $177.83 | $199.53 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $125.89 / $162.18
| Professional | 26 | $114.82 | $125.89 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $107.15
| Professional | TC | $52.48 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $234.42 / $257.04
| Professional | | $104.71 | $234.42 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $134.90 / $147.91
| Professional | 26 | $77.62 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $100.00 / $107.15
| Professional | TC | $26.30 | $100.00 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $190.55 / $251.19
| Professional | | $144.54 | $190.55 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $162.18
| Professional | 26 | $97.72 | $123.03 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $107.15
| Professional | TC | $43.65 | $64.57 | $107.15 |