- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $44.67 / $74.13
| Facility | 26 | $42.66 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $269.15
| Professional | | $102.33 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $66.07 / $117.49
| Professional | 26 | $30.90 | $66.07 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $97.72 / $190.55
| Professional | TC | $75.86 | $97.72 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $354.81
| Professional | | $239.88 | $316.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $107.15
| Professional | 26 | $74.13 | $97.72 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $218.78 / $245.47
| Professional | TC | $165.96 | $218.78 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $338.84
| Professional | | $112.20 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $63.10 / $97.72
| Professional | 26 | $37.15 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $147.91 / $239.88
| Professional | TC | $75.86 | $147.91 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $239.88 / $933.25
| Professional | | $134.90 | $239.88 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $72.44 / $269.15
| Professional | 26 | $41.69 | $72.44 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $660.69
| Professional | TC | $89.13 | $169.82 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $234.42 / $338.84
| Professional | | $100.00 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $74.13 / $114.82
| Professional | 26 | $38.02 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $158.49 / $251.19
| Professional | TC | $85.11 | $158.49 | $251.19 |