- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $37.15 / $61.66
| Facility | 26 | $36.31 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $257.04
| Professional | | $77.62 | $141.25 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $57.54 / $97.72
| Professional | 26 | $30.20 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $234.42
| Professional | TC | $46.77 | $67.61 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $213.80 / $234.42
| Professional | | $165.96 | $213.80 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $91.20
| Professional | 26 | $64.57 | $81.28 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $144.54
| Professional | TC | $102.33 | $131.83 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $229.09
| Professional | | $100.00 | $144.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $91.20
| Professional | 26 | $36.31 | $57.54 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $138.04
| Professional | TC | $56.23 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $173.78 / $602.56
| Professional | | $97.72 | $173.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $114.82
| Professional | 26 | $45.71 | $70.79 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $114.82 / $371.54
| Professional | TC | $58.88 | $114.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $162.18 / $223.87
| Professional | | $97.72 | $162.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $100.00
| Professional | 26 | $38.02 | $66.07 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $138.04
| Professional | TC | $61.66 | $100.00 | $138.04 |