- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $39.81
| Facility | 26 | $38.90 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $398.11
| Professional | | $134.90 | $239.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $66.07 / $112.20
| Professional | 26 | $35.48 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $245.47
| Professional | TC | $100.00 | $120.23 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $257.04
| Professional | | $138.04 | $223.87 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $426.58
| Professional | | $288.40 | $346.74 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $97.72
| Professional | 26 | $66.07 | $79.43 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $331.13
| Professional | TC | $208.93 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $1,348.96
| Professional | | $141.25 | $295.12 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $77.62 / $338.84
| Professional | 26 | $43.65 | $77.62 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $1,023.29
| Professional | TC | $125.89 | $229.09 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $331.13
| Professional | | $288.40 | $288.40 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $87.10
| Professional | 26 | $77.62 | $77.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $245.47
| Professional | TC | $208.93 | $208.93 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $309.03
| Professional | | $199.53 | $275.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $77.62
| Professional | 26 | $46.77 | $67.61 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $234.42
| Professional | TC | $144.54 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $295.12 / $426.58
| Professional | | $181.97 | $295.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $102.33
| Professional | 26 | $43.65 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $316.23
| Professional | TC | $138.04 | $223.87 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $354.81
| Professional | | $288.40 | $346.74 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $85.11
| Professional | 26 | $69.18 | $81.28 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $269.15
| Professional | TC | $223.87 | $263.03 | $269.15 |