- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $251.19
| Facility | 26 | $34.67 | $53.70 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $173.78 / $660.69
| Professional | | $102.33 | $173.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $109.65
| Professional | 26 | $35.48 | $42.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $263.03
| Professional | TC | $64.57 | $102.33 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $87.10 / $173.78
| Professional | | $85.11 | $87.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $74.13
| Professional | 26 | $31.62 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $575.44
| Professional | 26 | $47.86 | $47.86 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | 26 | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $204.17 / $354.81
| Professional | | $89.13 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $89.13
| Professional | 26 | $29.51 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $141.25 / $269.15
| Professional | TC | $56.23 | $141.25 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $181.97
| Professional | | $109.65 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $53.70 / $64.57
| Professional | 26 | $38.90 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $97.72 / $114.82
| Professional | TC | $69.18 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $117.49 / $223.87
| Professional | | $100.00 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $66.07
| Professional | 26 | $34.67 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $147.91
| Professional | TC | $64.57 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $288.40
| Professional | | $89.13 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $85.11
| Professional | 26 | $32.36 | $48.98 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $97.72 / $194.98
| Professional | TC | $57.54 | $97.72 | $194.98 |