- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $380.19
| Facility | 26 | $51.29 | $81.28 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $245.47 / $707.95
| Professional | | $158.49 | $245.47 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $85.11 / $165.96
| Professional | 26 | $52.48 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $295.12
| Professional | TC | $100.00 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $144.54 / $144.54
| Professional | | $131.83 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $50.12 / $87.10
| Professional | 26 | $45.71 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $371.54
| Professional | | $199.53 | $199.53 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $138.04
| Professional | 26 | $70.79 | $70.79 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | 26 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $295.12 / $501.19
| Professional | | $151.36 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $131.83
| Professional | 26 | $44.67 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $371.54
| Professional | TC | $112.20 | $208.93 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $269.15
| Professional | | $162.18 | $223.87 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $95.50
| Professional | 26 | $58.88 | $81.28 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $562.34
| Professional | TC | $120.23 | $151.36 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $331.13
| Professional | | $151.36 | $177.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $100.00
| Professional | 26 | $52.48 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $223.87
| Professional | TC | $97.72 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $239.88 / $436.52
| Professional | | $138.04 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $128.82
| Professional | 26 | $47.86 | $72.44 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $323.59
| Professional | TC | $91.20 | $162.18 | $323.59 |