- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $245.47
| Facility | 26 | $45.71 | $58.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $89.13 / $281.84
| Professional | | $47.86 | $89.13 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $107.15
| Professional | 26 | $23.99 | $38.02 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $53.70 / $91.20
| Professional | TC | $25.12 | $53.70 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $134.90
| Professional | | $70.79 | $120.23 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $64.57
| Professional | 26 | $28.84 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | TC | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $109.65 / $114.82
| Professional | | $102.33 | $109.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $51.29 / $53.70
| Professional | 26 | $47.86 | $51.29 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $57.54 / $63.10
| Professional | TC | $53.70 | $57.54 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | 26 | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $131.83 / $181.97
| Professional | | $46.77 | $131.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $58.88 / $81.28
| Professional | 26 | $22.39 | $58.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $70.79 / $107.15
| Professional | TC | $24.55 | $70.79 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $131.83
| Facility | 26 | $123.03 | $123.03 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $562.34
| Professional | | $66.07 | $109.65 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $186.21
| Professional | 26 | $33.88 | $50.12 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $60.26 / $398.11
| Professional | TC | $33.11 | $60.26 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $128.82 / $204.17
| Professional | | $114.82 | $128.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $60.26 / $93.33
| Professional | 26 | $52.48 | $60.26 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $64.57 / $112.20
| Professional | TC | $60.26 | $64.57 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Facility | 26 | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $151.36 / $154.88
| Professional | | $134.90 | $151.36 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $67.61
| Professional | 26 | $47.86 | $56.23 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $107.15
| Professional | TC | $70.79 | $95.50 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $123.03
| Professional | | $28.18 | $56.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $181.97
| Professional | | $66.07 | $104.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $70.79
| Professional | 26 | $33.11 | $44.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $100.00
| Professional | TC | $33.11 | $56.23 | $100.00 |