- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $44.67 / $120.23
| Facility | 26 | $22.91 | $44.67 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $151.36 / $489.78
| Professional | | $72.44 | $151.36 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $61.66 / $123.03
| Professional | 26 | $26.92 | $61.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $83.18 / $208.93
| Professional | TC | $45.71 | $83.18 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $194.98 / $194.98
| Facility | 26 | $70.79 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $660.69
| Professional | | $83.18 | $134.90 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $229.09
| Professional | 26 | $26.30 | $40.74 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $457.09
| Professional | TC | $60.26 | $100.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $218.78 / $295.12
| Professional | | $128.82 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $77.62
| Professional | 26 | $34.67 | $58.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $138.04 / $288.40
| Professional | | $77.62 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $43.65 / $85.11
| Professional | 26 | $23.99 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $97.72 / $213.80
| Professional | TC | $50.12 | $97.72 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $97.72 / $190.55
| Professional | | $36.31 | $97.72 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $263.03
| Professional | | $100.00 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $77.62
| Professional | 26 | $30.20 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $123.03 / $181.97
| Professional | TC | $70.79 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $213.80
| Professional | | $43.65 | $58.88 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $194.98 / $194.98
| Facility | 26 | $70.79 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $660.69
| Professional | | $83.18 | $134.90 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $229.09
| Professional | 26 | $26.30 | $40.74 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $457.09
| Professional | TC | $60.26 | $100.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $100.00 / $181.97
| Professional | | $50.12 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $141.25 / $295.12
| Professional | | $91.20 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $93.33
| Professional | 26 | $28.84 | $43.65 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $102.33 / $208.93
| Professional | TC | $63.10 | $102.33 | $208.93 |