- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 26 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $281.84 / $891.25
| Professional | | $229.09 | $281.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $165.96 / $363.08
| Professional | 26 | $141.25 | $165.96 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $162.18
| Professional | TC | $83.18 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $239.88 / $257.04
| Professional | | $234.42 | $239.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $363.08
| Professional | 26 | $141.25 | $141.25 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $316.23 / $446.68
| Professional | | $213.80 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $275.42
| Professional | 26 | $131.83 | $186.21 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $181.97
| Professional | TC | $83.18 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $309.03 / $446.68
| Professional | | $234.42 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $194.98 / $275.42
| Professional | 26 | $141.25 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $123.03 / $173.78
| Professional | TC | $93.33 | $123.03 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $257.04 / $380.19
| Professional | | $1.91 | $257.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.15 / $158.49 / $234.42
| Professional | 26 | $1.15 | $158.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.76 / $100.00 / $141.25
| Professional | TC | $0.76 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.91 / $1.91 / $380.19
| Professional | | $1.91 | $1.91 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.15 / $1.15 / $234.42
| Professional | 26 | $1.15 | $1.15 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.76 / $0.76 / $144.54
| Professional | TC | $0.76 | $0.76 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $436.52
| Professional | | $234.42 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $158.49 / $281.84
| Professional | 26 | $147.91 | $158.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $154.88
| Professional | TC | $85.11 | $95.50 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $416.87
| Professional | | $186.21 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $288.40
| Professional | 26 | $144.54 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $190.55
| Professional | TC | $93.33 | $134.90 | $190.55 |