- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $60.26
| Facility | 26 | $41.69 | $52.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $107.15 / $229.09
| Professional | | $69.18 | $107.15 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $91.20
| Professional | 26 | $30.20 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $97.72
| Professional | TC | $36.31 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $141.25
| Professional | | $57.54 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $58.88
| Professional | 26 | $28.84 | $38.02 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $125.89
| Professional | | $87.10 | $100.00 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $45.71 / $58.88
| Professional | 26 | $39.81 | $45.71 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $52.48 / $67.61
| Professional | TC | $46.77 | $52.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $60.26 / $107.15
| Professional | | $38.90 | $60.26 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $41.69 / $58.88
| Facility | 26 | $8.91 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $162.18
| Professional | | $67.61 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $46.77 / $74.13
| Professional | 26 | $29.51 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $61.66 / $89.13
| Professional | TC | $37.15 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $181.97
| Professional | | $107.15 | $141.25 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $77.62
| Professional | 26 | $37.15 | $70.79 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $93.33 / $97.72
| Professional | TC | $91.20 | $93.33 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $165.96
| Professional | | $77.62 | $97.72 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $43.65 / $75.86
| Professional | 26 | $33.88 | $43.65 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $54.95 / $95.50
| Professional | TC | $42.66 | $54.95 | $95.50 |