- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $165.96 / $169.82
| Facility | 26 | $158.49 | $165.96 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $239.88 / $489.78
| Professional | | $120.23 | $239.88 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $194.98
| Professional | 26 | $70.79 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $134.90
| Professional | TC | $51.29 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $331.13
| Professional | | $123.03 | $269.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $190.55
| Professional | 26 | $89.13 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $275.42
| Professional | | $123.03 | $204.17 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $162.18
| Professional | 26 | $72.44 | $120.23 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $114.82
| Professional | TC | $50.12 | $83.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $371.54
| Professional | | $186.21 | $295.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $208.93
| Professional | 26 | $100.00 | $165.96 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $165.96
| Professional | TC | $85.11 | $125.89 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Facility | 26 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $275.42 / $870.96
| Professional | | $213.80 | $275.42 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $501.19
| Professional | 26 | $125.89 | $158.49 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $380.19
| Professional | TC | $95.50 | $117.49 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $295.12 / $371.54
| Professional | | $263.03 | $295.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $165.96 / $208.93
| Professional | 26 | $154.88 | $165.96 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $125.89 / $165.96
| Professional | TC | $109.65 | $125.89 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $323.59
| Professional | | $186.21 | $295.12 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $194.98
| Professional | 26 | $100.00 | $177.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $131.83
| Professional | TC | $85.11 | $123.03 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $346.74
| Professional | | $186.21 | $263.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $194.98
| Professional | 26 | $104.71 | $151.36 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $144.54
| Professional | TC | $74.13 | $109.65 | $144.54 |