- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $169.82 / $199.53
| Facility | 26 | $41.69 | $169.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $338.84
| Professional | | $102.33 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $117.49
| Professional | 26 | $32.36 | $54.95 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $218.78
| Professional | TC | $74.13 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $302.00
| Professional | | $114.82 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $85.11
| Professional | 26 | $33.11 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $208.93
| Professional | TC | $83.18 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $199.53 / $407.38
| Professional | | $114.82 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $93.33
| Professional | 26 | $35.48 | $53.70 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $281.84
| Professional | TC | $77.62 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $147.91 / $208.93
| Professional | | $123.03 | $147.91 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $54.95 / $67.61
| Professional | 26 | $31.62 | $54.95 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $158.49
| Professional | TC | $93.33 | $125.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $69.18 / $89.13
| Professional | | $60.26 | $69.18 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $354.81
| Professional | | $107.15 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $112.20
| Professional | 26 | $33.88 | $53.70 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $123.03 / $208.93
| Professional | TC | $81.28 | $123.03 | $208.93 |