- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $87.10
| Facility | 26 | $39.81 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $371.54
| Professional | | $70.79 | $95.50 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $138.04
| Professional | 26 | $35.48 | $46.77 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $218.78
| Professional | TC | $30.90 | $46.77 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $58.88 / $60.26
| Professional | | $57.54 | $58.88 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $28.18 / $61.66
| Professional | 26 | $27.54 | $28.18 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $229.09
| Professional | | $66.07 | $83.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $77.62
| Professional | 26 | $38.90 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $154.88
| Professional | TC | $27.54 | $35.48 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $87.10 / $114.82
| Professional | | $81.28 | $87.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $41.69 / $56.23
| Professional | 26 | $39.81 | $41.69 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $44.67 / $58.88
| Professional | TC | $41.69 | $44.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $42.66 / $61.66
| Facility | 26 | $9.12 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $112.20 / $239.88
| Professional | | $63.10 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $93.33
| Professional | 26 | $33.11 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $58.88 / $154.88
| Professional | TC | $30.90 | $58.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $169.82
| Facility | 26 | $89.13 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $1,000.00
| Professional | | $69.18 | $120.23 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $53.70 / $239.88
| Professional | 26 | $36.31 | $53.70 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $54.95 / $776.25
| Professional | TC | $30.20 | $54.95 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $93.33 / $199.53
| Professional | | $66.07 | $93.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $102.33
| Professional | 26 | $36.31 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $107.15
| Professional | TC | $29.51 | $42.66 | $107.15 |