- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $63.10 / $117.49
| Facility | 26 | $54.95 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $457.09
| Professional | | $128.82 | $173.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $144.54
| Professional | 26 | $48.98 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $223.87
| Professional | TC | $83.18 | $109.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $107.15 / $234.42
| Professional | | $100.00 | $107.15 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $85.11
| Professional | 26 | $38.02 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $151.36
| Professional | TC | $53.70 | $63.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $154.88 / $269.15
| Professional | | $134.90 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $57.54 / $97.72
| Professional | 26 | $51.29 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $100.00 / $165.96
| Professional | TC | $83.18 | $100.00 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $147.91 / $194.98
| Professional | | $141.25 | $147.91 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $72.44
| Professional | 26 | $53.70 | $54.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $93.33 / $123.03
| Professional | TC | $87.10 | $93.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $57.54 / $83.18
| Facility | 26 | $12.59 | $57.54 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $309.03
| Professional | | $123.03 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $67.61 / $125.89
| Professional | 26 | $43.65 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $204.17
| Professional | TC | $77.62 | $120.23 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $478.63 / $478.63
| Facility | 26 | $371.54 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $186.21 / $912.01
| Professional | | $134.90 | $186.21 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $323.59
| Professional | 26 | $47.86 | $69.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $588.84
| Professional | TC | $87.10 | $123.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $173.78 / $316.23
| Professional | | $134.90 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $120.23
| Professional | 26 | $48.98 | $64.57 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $194.98
| Professional | TC | $87.10 | $112.20 | $194.98 |