- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $33.88 / $69.18
| Facility | 26 | $19.05 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $269.15
| Professional | | $67.61 | $107.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $56.23
| Professional | 26 | $15.14 | $19.95 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $177.83
| Professional | TC | $52.48 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $24.55 / $57.54
| Professional | 26 | $19.95 | $24.55 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $223.87
| Professional | | $97.72 | $151.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $27.54 / $39.81
| Professional | 26 | $17.78 | $27.54 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $123.03 / $181.97
| Professional | TC | $81.28 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $302.00
| Professional | | $100.00 | $141.25 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $51.29
| Professional | 26 | $19.50 | $27.54 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $251.19
| Professional | TC | $77.62 | $114.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $263.03
| Professional | | $114.82 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $48.98
| Professional | 26 | $20.42 | $32.36 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $223.87
| Professional | TC | $95.50 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $138.04 / $263.03
| Professional | | $102.33 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $53.70
| Professional | 26 | $19.50 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $245.47
| Professional | TC | $87.10 | $114.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $14.45 / $17.78
| Facility | 26 | $13.18 | $14.45 | $17.78 |