- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $63.10 / $128.82
| Facility | 26 | $33.88 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $245.47
| Professional | | $104.71 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $117.49
| Professional | 26 | $26.92 | $47.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $162.18
| Professional | TC | $77.62 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Professional | 26 | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $234.42 / $309.03
| Professional | | $147.91 | $234.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $100.00
| Professional | 26 | $47.86 | $75.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $218.78
| Professional | TC | $100.00 | $158.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $234.42 / $457.09
| Professional | | $151.36 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $128.82
| Professional | 26 | $40.74 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $323.59
| Professional | TC | $100.00 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $398.11
| Professional | | $162.18 | $269.15 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $125.89
| Professional | 26 | $54.95 | $85.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $269.15
| Professional | TC | $117.49 | $181.97 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $234.42 / $457.09
| Professional | | $147.91 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $125.89
| Professional | 26 | $46.77 | $69.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $316.23
| Professional | TC | $107.15 | $151.36 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $47.86
| Facility | 26 | $36.31 | $39.81 | $47.86 |