- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $102.33
| Facility | 26 | $32.36 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $338.84
| Professional | | $87.10 | $114.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $89.13
| Professional | 26 | $27.54 | $44.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $154.88
| Professional | TC | $58.88 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $53.70
| Professional | 26 | $20.89 | $24.55 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $194.98
| Professional | | $97.72 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $63.10
| Professional | 26 | $33.88 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $134.90
| Professional | TC | $64.57 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $147.91
| Professional | | $107.15 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $48.98
| Professional | 26 | $34.67 | $36.31 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $100.00
| Professional | TC | $72.44 | $79.43 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $38.02 / $53.70
| Facility | 26 | $8.13 | $38.02 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $245.47
| Professional | | $87.10 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $83.18
| Professional | 26 | $28.84 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $173.78
| Professional | TC | $60.26 | $93.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $151.36 / $151.36
| Facility | 26 | $77.62 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $724.44
| Professional | | $100.00 | $134.90 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $208.93
| Professional | 26 | $31.62 | $43.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $524.81
| Professional | TC | $63.10 | $91.20 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $218.78
| Professional | | $93.33 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $79.43
| Professional | 26 | $32.36 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $134.90
| Professional | TC | $63.10 | $81.28 | $134.90 |