- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $125.89 / $147.91
| Facility | 26 | $39.81 | $125.89 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $467.74
| Professional | | $95.50 | $186.21 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $109.65
| Professional | 26 | $26.92 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $223.87
| Professional | TC | $66.07 | $100.00 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $281.84
| Professional | | $125.89 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $67.61
| Professional | 26 | $29.51 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $213.80
| Professional | TC | $93.33 | $131.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $208.93 / $512.86
| Professional | | $120.23 | $208.93 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $83.18
| Professional | 26 | $35.48 | $46.77 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $165.96 / $457.09
| Professional | TC | $75.86 | $165.96 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $194.98
| Professional | | $138.04 | $162.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $42.66 / $51.29
| Professional | 26 | $37.15 | $42.66 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $151.36
| Professional | TC | $107.15 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $151.36 / $323.59
| Professional | | $45.71 | $151.36 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $380.19
| Professional | | $107.15 | $181.97 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $75.86
| Professional | 26 | $26.30 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $141.25 / $331.13
| Professional | TC | $79.43 | $141.25 | $331.13 |