- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $75.86
| Facility | 26 | $38.02 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $229.09 / $724.44
| Professional | | $131.83 | $229.09 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $173.78
| Professional | 26 | $36.31 | $63.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $302.00
| Professional | TC | $97.72 | $141.25 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $120.23
| Professional | | $97.72 | $117.49 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.84 / $56.23
| Professional | 26 | $28.18 | $28.84 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $229.09 / $380.19
| Professional | | $173.78 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $69.18 / $114.82
| Professional | 26 | $50.12 | $69.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $263.03
| Professional | TC | $120.23 | $158.49 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $151.36 / $190.55
| Professional | | $141.25 | $151.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $38.02 / $46.77
| Professional | 26 | $35.48 | $38.02 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $141.25
| Professional | TC | $107.15 | $114.82 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $128.82 / $213.80
| Professional | | $38.02 | $128.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $371.54
| Professional | | $151.36 | $218.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $100.00
| Professional | 26 | $38.02 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $269.15
| Professional | TC | $112.20 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $354.81
| Professional | | $141.25 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $61.66 / $114.82
| Professional | 26 | $36.31 | $61.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $257.04
| Professional | TC | $109.65 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $97.72
| Professional | | $32.36 | $33.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Facility | 26 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $181.97 / $309.03
| Professional | | $141.25 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $85.11
| Professional | 26 | $38.02 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $128.82 / $229.09
| Professional | TC | $102.33 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $354.81
| Professional | | $131.83 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $95.50
| Professional | 26 | $33.88 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $257.04
| Professional | TC | $100.00 | $141.25 | $257.04 |