- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $91.20 / $91.20
| Facility | 26 | $81.28 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $338.84 / $660.69
| Professional | | $245.47 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $354.81
| Professional | 26 | $52.48 | $95.50 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $239.88 / $562.34
| Professional | TC | $162.18 | $239.88 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 26 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $512.86
| Professional | | $407.38 | $489.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $109.65
| Professional | 26 | $85.11 | $104.71 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $380.19 / $398.11
| Professional | TC | $323.59 | $380.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $707.95
| Professional | | $302.00 | $416.87 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $154.88
| Professional | 26 | $64.57 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $549.54
| Professional | TC | $223.87 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $776.25
| Professional | | $512.86 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | 26 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $338.84 / $338.84
| Professional | TC | $85.11 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $91.20 / $95.50
| Facility | 26 | $81.28 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $446.68 / $660.69
| Professional | | $257.04 | $446.68 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $223.87
| Professional | 26 | $58.88 | $97.72 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $562.34
| Professional | TC | $199.53 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $169.82
| Professional | | $32.36 | $33.11 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 26 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $537.03
| Professional | | $338.84 | $398.11 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $109.65
| Professional | 26 | $69.18 | $81.28 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $426.58
| Professional | TC | $269.15 | $316.23 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $269.15 / $630.96
| Professional | | $239.88 | $269.15 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $93.33
| Professional | 26 | $50.12 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $346.74
| Professional | TC | $190.55 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $616.60
| Professional | | $281.84 | $446.68 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $144.54
| Professional | 26 | $58.88 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $478.63
| Professional | TC | $229.09 | $363.08 | $478.63 |