- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $87.10
| Facility | 26 | $72.44 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $302.00 / $676.08
| Professional | | $208.93 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $190.55
| Professional | 26 | $54.95 | $72.44 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $398.11
| Professional | TC | $158.49 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $47.86
| Professional | 26 | $46.77 | $46.77 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $363.08
| Professional | | $208.93 | $251.19 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $100.00
| Professional | 26 | $56.23 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $302.00
| Professional | TC | $151.36 | $186.21 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $602.56
| Professional | | $213.80 | $346.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $114.82
| Professional | 26 | $53.70 | $83.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $446.68
| Professional | TC | $158.49 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $269.15 / $363.08
| Professional | | $2.95 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.78 / $72.44 / $95.50
| Professional | 26 | $0.78 | $72.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $194.98 / $263.03
| Professional | TC | $10.96 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $316.23
| Professional | | $2.95 | $2.95 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.78 / $0.78 / $87.10
| Professional | 26 | $0.78 | $0.78 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.19 / $151.36 / $229.09
| Professional | TC | $2.19 | $151.36 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $208.93 / $223.87
| Professional | | $199.53 | $208.93 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $60.26
| Professional | 26 | $57.54 | $57.54 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $151.36 / $162.18
| Professional | TC | $141.25 | $151.36 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $302.00 / $489.78
| Professional | | $181.97 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $117.49
| Professional | 26 | $52.48 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $446.68
| Professional | TC | $151.36 | $223.87 | $446.68 |