- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $72.44
| Facility | 26 | $43.65 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $354.81
| Professional | | $89.13 | $138.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $54.95 / $95.50
| Professional | 26 | $25.70 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $107.15 / $812.83
| Professional | TC | $53.70 | $107.15 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $109.65
| Professional | | $25.70 | $25.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $66.07
| Professional | 26 | $16.60 | $16.60 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $9.55 / $42.66
| Professional | TC | $9.33 | $9.55 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $102.33 / $173.78
| Professional | | $38.90 | $102.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $44.67 / $63.10
| Facility | 26 | $9.55 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $112.20 / $676.08
| Professional | | $64.57 | $112.20 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $45.71 / $213.80
| Professional | 26 | $16.60 | $45.71 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $512.86
| Professional | TC | $40.74 | $60.26 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $208.93
| Professional | | $70.79 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $41.69 / $83.18
| Professional | 26 | $32.36 | $41.69 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $79.43 / $134.90
| Professional | TC | $39.81 | $79.43 | $134.90 |