- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $53.70 / $70.79
| Facility | 26 | $19.95 | $53.70 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $213.80
| Professional | | $97.72 | $128.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $177.83
| Professional | TC | $77.62 | $107.15 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $229.09
| Professional | | $109.65 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $177.83
| Professional | TC | $85.11 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $158.49 / $190.55
| Professional | | $141.25 | $158.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $154.88
| Professional | TC | $109.65 | $131.83 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $38.02
| Facility | 26 | $5.62 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $275.42
| Professional | | $102.33 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $263.03
| Professional | TC | $79.43 | $125.89 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $104.71 / $104.71
| Facility | 26 | $54.95 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $933.25
| Professional | | $109.65 | $162.18 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $138.04 / $776.25
| Professional | TC | $85.11 | $138.04 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $134.90 / $245.47
| Professional | | $104.71 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $194.98
| Professional | TC | $83.18 | $107.15 | $194.98 |