- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $60.26 / $165.96
| Facility | 26 | $46.77 | $60.26 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $588.84
| Professional | | $194.98 | $281.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $144.54
| Professional | 26 | $41.69 | $57.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $489.78
| Professional | TC | $162.18 | $229.09 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $245.47 / $288.40
| Professional | | $204.17 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | 26 | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $239.88 / $512.86
| Professional | | $204.17 | $239.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $91.20
| Professional | 26 | $32.36 | $39.81 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $416.87
| Professional | TC | $169.82 | $199.53 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $316.23 / $380.19
| Professional | | $66.07 | $316.23 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $51.29 / $72.44
| Facility | 26 | $10.96 | $51.29 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $1,000.00
| Professional | | $251.19 | $416.87 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $158.49
| Professional | 26 | $41.69 | $67.61 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $338.84 / $891.25
| Professional | TC | $204.17 | $338.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $562.34
| Professional | | $288.40 | $380.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $338.84
| Professional | 26 | $51.29 | $74.13 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $323.59 / $467.74
| Professional | TC | $263.03 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $575.44
| Professional | | $177.83 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $97.72
| Professional | 26 | $35.48 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $281.84 / $478.63
| Professional | TC | $134.90 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | 26 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $371.54 / $602.56
| Professional | | $316.23 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $102.33
| Professional | 26 | $53.70 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $309.03 / $501.19
| Professional | TC | $263.03 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $1,047.13
| Professional | | $257.04 | $389.05 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $64.57 / $169.82
| Professional | 26 | $43.65 | $64.57 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $912.01
| Professional | TC | $213.80 | $323.59 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $158.49
| Facility | 26 | $37.15 | $53.70 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $691.83
| Professional | | $181.97 | $323.59 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $53.70 / $134.90
| Professional | 26 | $36.31 | $53.70 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $269.15 / $616.60
| Professional | TC | $138.04 | $269.15 | $616.60 |