- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $93.33
| Facility | 26 | $74.13 | $74.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $602.56
| Professional | | $169.82 | $275.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $85.11 / $213.80
| Professional | 26 | $53.70 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $436.52
| Professional | TC | $114.82 | $186.21 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $81.28 / $100.00
| Professional | 26 | $45.71 | $81.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $257.04 / $275.42
| Professional | | $169.82 | $257.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $123.03
| Professional | 26 | $91.20 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $323.59 / $549.54
| Professional | | $173.78 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $75.86 / $151.36
| Professional | 26 | $43.65 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $380.19
| Professional | TC | $117.49 | $204.17 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $75.86 / $138.04
| Facility | 26 | $74.13 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $549.54
| Professional | | $177.83 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $169.82
| Professional | 26 | $52.48 | $74.13 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $436.52
| Professional | TC | $120.23 | $199.53 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $275.42 / $549.54
| Professional | | $173.78 | $275.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $107.15
| Professional | 26 | $48.98 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $331.13
| Professional | TC | $117.49 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $257.04 / $446.68
| Professional | | $177.83 | $257.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $363.08
| Professional | 26 | $54.95 | $72.44 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $338.84
| Professional | TC | $123.03 | $186.21 | $338.84 |