- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $43.65
| Facility | 26 | $30.20 | $41.69 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $323.59
| Professional | | $67.61 | $120.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $70.79
| Professional | 26 | $25.12 | $36.31 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $85.11 / $218.78
| Professional | TC | $42.66 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $114.82 / $144.54
| Professional | | $100.00 | $114.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $33.88 / $43.65
| Professional | 26 | $29.51 | $33.88 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $79.43 / $102.33
| Professional | TC | $69.18 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $87.10 / $151.36
| Professional | | $30.20 | $87.10 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $44.67
| Facility | 26 | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $204.17
| Professional | | $85.11 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $36.31 / $60.26
| Professional | 26 | $23.99 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $141.25
| Professional | TC | $60.26 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $64.57
| Professional | 26 | $34.67 | $52.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $208.93
| Professional | | $87.10 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $58.88
| Professional | 26 | $25.12 | $33.11 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $154.88
| Professional | TC | $61.66 | $79.43 | $154.88 |