- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $162.18
| Facility | 26 | $35.48 | $61.66 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $660.69
| Professional | | $104.71 | $165.96 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $123.03
| Professional | 26 | $36.31 | $42.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $269.15
| Professional | TC | $64.57 | $100.00 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $251.19
| Professional | | $102.33 | $147.91 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $81.28
| Professional | 26 | $38.02 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $158.49
| Professional | TC | $66.07 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $151.36 / $707.95
| Professional | | $61.66 | $151.36 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $72.44
| Professional | 26 | $39.81 | $52.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $151.36
| Professional | TC | $89.13 | $109.65 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $199.53 / $354.81
| Professional | | $93.33 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $91.20
| Professional | 26 | $31.62 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $257.04
| Professional | TC | $58.88 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $125.89 / $162.18
| Professional | | $104.71 | $125.89 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $57.54
| Professional | 26 | $36.31 | $44.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $107.15
| Professional | TC | $66.07 | $81.28 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $354.81
| Professional | | $245.47 | $346.74 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $74.13 / $87.10
| Professional | 26 | $60.26 | $74.13 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $223.87
| Professional | | $177.83 | $177.83 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $165.96 / $870.96
| Professional | | $51.29 | $165.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $91.20
| Professional | 26 | $41.69 | $54.95 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $134.90 / $229.09
| Professional | TC | $72.44 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $165.96 / $380.19
| Professional | | $91.20 | $165.96 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $51.29 / $97.72
| Professional | 26 | $28.84 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $263.03
| Professional | TC | $58.88 | $109.65 | $263.03 |