- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $263.03
| Facility | 26 | $134.90 | $234.42 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $562.34
| Professional | | $169.82 | $208.93 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $114.82 / $263.03
| Professional | 26 | $95.50 | $114.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $162.18
| Professional | TC | $67.61 | $83.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $117.49 / $165.96
| Facility | 26 | $25.12 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $501.19
| Professional | | $208.93 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $281.84
| Professional | 26 | $114.82 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $213.80
| Professional | TC | $91.20 | $147.91 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $416.87 / $467.74
| Professional | | $354.81 | $416.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $234.42 / $269.15
| Professional | 26 | $204.17 | $234.42 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $199.53
| Professional | TC | $147.91 | $177.83 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $263.03
| Facility | 26 | $134.90 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $512.86
| Professional | | $204.17 | $346.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $213.80 / $309.03
| Professional | 26 | $112.20 | $213.80 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $223.87
| Professional | TC | $83.18 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $223.87
| Professional | | $102.33 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $489.78
| Professional | | $257.04 | $371.54 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $204.17 / $288.40
| Professional | 26 | $128.82 | $204.17 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $213.80
| Professional | TC | $100.00 | $158.49 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 26 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $501.19
| Professional | | $295.12 | $371.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $295.12
| Professional | 26 | $173.78 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $208.93
| Professional | TC | $123.03 | $162.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $501.19
| Professional | | $194.98 | $363.08 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $302.00
| Professional | 26 | $117.49 | $204.17 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $218.78
| Professional | TC | $89.13 | $158.49 | $218.78 |