- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Facility | 26 | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $147.91
| Professional | | $48.98 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.79 / $31.62
| Professional | 26 | $10.96 | $14.79 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $89.13
| Professional | TC | $33.88 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $117.49
| Professional | | $53.70 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $28.84
| Professional | 26 | $14.13 | $19.05 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $87.10
| Professional | TC | $37.15 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $85.11
| Professional | | $27.54 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $100.00 / $112.20
| Professional | | $83.18 | $100.00 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $21.38 / $32.36
| Professional | 26 | $18.20 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $85.11
| Professional | TC | $64.57 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $109.65
| Professional | | $58.88 | $93.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $21.38 / $28.18
| Professional | 26 | $13.18 | $21.38 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $81.28
| Professional | TC | $46.77 | $70.79 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $67.61 / $109.65
| Professional | | $19.05 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $93.33
| Professional | | $48.98 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $14.79 / $23.44
| Professional | 26 | $13.18 | $14.79 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $70.79
| Professional | TC | $35.48 | $42.66 | $70.79 |