- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $109.65 / $114.82
| Facility | 26 | $107.15 | $109.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $1,148.15
| Professional | | $229.09 | $363.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $416.87
| Professional | 26 | $77.62 | $128.82 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $302.00
| Professional | TC | $138.04 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $309.03
| Professional | | $213.80 | $229.09 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $158.49
| Professional | 26 | $79.43 | $81.28 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $338.84 / $363.08
| Professional | | $275.42 | $338.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Professional | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $380.19
| Professional | TC | $239.88 | $239.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $177.83 / $302.00
| Professional | | $83.18 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $676.08
| Professional | | $218.78 | $309.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $239.88
| Professional | 26 | $83.18 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $194.98 / $457.09
| Professional | TC | $147.91 | $194.98 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $109.65 / $229.09
| Facility | 26 | $107.15 | $109.65 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $851.14
| Professional | | $234.42 | $309.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $331.13
| Professional | 26 | $79.43 | $109.65 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $331.13
| Professional | TC | $151.36 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $489.78
| Professional | | $204.17 | $281.84 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $154.88
| Professional | 26 | $81.28 | $104.71 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $181.97 / $331.13
| Professional | TC | $141.25 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $426.58
| Professional | | $229.09 | $302.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $158.49
| Professional | 26 | $83.18 | $104.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $186.21 / $288.40
| Professional | TC | $144.54 | $186.21 | $288.40 |