- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $138.04
| Facility | 26 | $26.92 | $34.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $870.96
| Professional | | $229.09 | $323.59 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $190.55
| Professional | 26 | $26.92 | $46.77 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $645.65
| Professional | TC | $204.17 | $275.42 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $85.11 / $125.89
| Facility | 26 | $38.02 | $85.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $1,445.44
| Professional | | $239.88 | $407.38 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $42.66 / $158.49
| Professional | 26 | $25.70 | $42.66 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $1,348.96
| Professional | TC | $213.80 | $363.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $102.33
| Professional | 26 | $54.95 | $67.61 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $630.96 / $1,000.00
| Professional | | $389.05 | $630.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $104.71
| Professional | 26 | $42.66 | $69.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $891.25
| Professional | TC | $354.81 | $562.34 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $354.81 / $524.81
| Professional | | $44.67 | $354.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $407.38 / $794.33
| Professional | | $295.12 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $89.13
| Professional | 26 | $34.67 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $660.69
| Professional | TC | $257.04 | $316.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $53.70
| Professional | | $48.98 | $48.98 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $85.11 / $125.89
| Facility | 26 | $38.02 | $85.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $1,445.44
| Professional | | $239.88 | $407.38 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $42.66 / $158.49
| Professional | 26 | $25.70 | $42.66 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $1,348.96
| Professional | TC | $213.80 | $363.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $537.03 / $1,023.29
| Professional | | $346.74 | $537.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $107.15
| Professional | 26 | $34.67 | $50.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $436.52 / $831.76
| Professional | TC | $302.00 | $436.52 | $831.76 |