- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $93.33 / $223.87
| Facility | 26 | $43.65 | $93.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $794.33
| Professional | | $128.82 | $223.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $186.21
| Professional | 26 | $51.29 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $346.74
| Professional | TC | $77.62 | $120.23 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $363.08 / $363.08
| Facility | 26 | $131.83 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $263.03 / $1,621.81
| Professional | | $125.89 | $263.03 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $398.11
| Professional | 26 | $50.12 | $79.43 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $186.21 / $1,659.59
| Professional | TC | $87.10 | $186.21 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $371.54 / $616.60
| Professional | | $213.80 | $371.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $144.54
| Professional | 26 | $64.57 | $109.65 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $257.04 / $446.68
| Professional | | $120.23 | $257.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $165.96
| Professional | 26 | $46.77 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $173.78 / $302.00
| Professional | TC | $72.44 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $257.04
| Professional | | $69.18 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $223.87 / $380.19
| Professional | | $141.25 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $151.36
| Professional | 26 | $56.23 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $229.09
| Professional | TC | $89.13 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $457.09
| Professional | | $79.43 | $100.00 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $363.08 / $363.08
| Facility | 26 | $131.83 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $263.03 / $1,621.81
| Professional | | $125.89 | $263.03 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $398.11
| Professional | 26 | $50.12 | $79.43 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $186.21 / $1,659.59
| Professional | TC | $87.10 | $186.21 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $245.47 / $457.09
| Professional | | $147.91 | $245.47 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $199.53
| Professional | 26 | $56.23 | $81.28 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $331.13
| Professional | TC | $91.20 | $147.91 | $331.13 |