- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $97.72
| Facility | 26 | $61.66 | $85.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $309.03 / $954.99
| Professional | | $190.55 | $309.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $74.13 / $165.96
| Professional | 26 | $32.36 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $309.03 / $794.33
| Professional | TC | $158.49 | $309.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $776.25
| Professional | | $295.12 | $524.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $104.71
| Professional | 26 | $52.48 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $446.68 / $676.08
| Professional | TC | $257.04 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $645.65 / $741.31
| Professional | | $549.54 | $645.65 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $100.00
| Professional | 26 | $72.44 | $87.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $562.34 / $645.65
| Professional | TC | $478.63 | $562.34 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $85.11 / $97.72
| Facility | 26 | $47.86 | $85.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $851.14
| Professional | | $251.19 | $489.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $123.03
| Professional | 26 | $38.90 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $741.31
| Professional | TC | $245.47 | $467.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $120.23 / $549.54
| Professional | | $47.86 | $120.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $549.54 / $776.25
| Professional | | $338.84 | $549.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $107.15
| Professional | 26 | $52.48 | $70.79 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $436.52 / $660.69
| Professional | TC | $269.15 | $436.52 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Facility | 26 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $758.58
| Professional | | $489.78 | $616.60 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $104.71
| Professional | 26 | $67.61 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $537.03 / $645.65
| Professional | TC | $416.87 | $537.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $812.83
| Professional | | $229.09 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $47.86 / $100.00
| Professional | 26 | $42.66 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $691.83
| Professional | TC | $194.98 | $309.03 | $691.83 |