- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $34.67 / $56.23
| Facility | 26 | $33.11 | $34.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $165.96
| Professional | | $66.07 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $83.18
| Professional | 26 | $25.70 | $34.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $48.98 / $100.00
| Professional | TC | $38.02 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $208.93
| Professional | | $141.25 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $85.11
| Professional | 26 | $57.54 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $123.03
| Professional | TC | $85.11 | $112.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $123.03 / $208.93
| Professional | | $81.28 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $85.11
| Professional | 26 | $33.11 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $75.86 / $123.03
| Professional | TC | $47.86 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $147.91 / $549.54
| Professional | | $79.43 | $147.91 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $208.93
| Professional | 26 | $33.88 | $64.57 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $338.84
| Professional | TC | $45.71 | $85.11 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $141.25 / $204.17
| Professional | | $79.43 | $141.25 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $100.00
| Professional | 26 | $35.48 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $81.28 / $125.89
| Professional | TC | $45.71 | $81.28 | $125.89 |