- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $141.25 / $194.98
| Facility | 26 | $53.70 | $141.25 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $691.83
| Professional | | $104.71 | $181.97 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $141.25
| Professional | 26 | $36.31 | $44.67 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $117.49 / $281.84
| Professional | TC | $64.57 | $117.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $91.20
| Professional | | $51.29 | $81.28 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $69.18
| Professional | 26 | $30.20 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $245.47
| Professional | | $123.03 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $44.67 / $79.43
| Professional | 26 | $39.81 | $44.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $162.18
| Professional | TC | $81.28 | $102.33 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $45.71 / $66.07
| Facility | 26 | $9.77 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $338.84
| Professional | | $89.13 | $165.96 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $89.13
| Professional | 26 | $30.90 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $109.65 / $223.87
| Professional | TC | $56.23 | $109.65 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $380.19 / $380.19
| Facility | 26 | $295.12 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $1,258.93
| Professional | | $100.00 | $186.21 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $316.23
| Professional | 26 | $34.67 | $47.86 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $147.91 / $1,096.48
| Professional | TC | $63.10 | $147.91 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $323.59
| Professional | | $95.50 | $158.49 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $107.15
| Professional | 26 | $34.67 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $104.71 / $218.78
| Professional | TC | $63.10 | $104.71 | $218.78 |