- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | 26 | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $134.90 / $331.13
| Professional | | $91.20 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $144.54
| Professional | 26 | $25.70 | $38.02 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $323.59
| Professional | TC | $52.48 | $100.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $524.81
| Professional | | $234.42 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $128.82
| Professional | 26 | $56.23 | $87.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $295.12 / $407.38
| Professional | TC | $181.97 | $295.12 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $263.03 / $309.03
| Facility | 26 | $57.54 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $309.03
| Professional | | $194.98 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $57.54 / $74.13
| Professional | 26 | $45.71 | $57.54 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $239.88
| Professional | TC | $147.91 | $186.21 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $245.47 / $245.47
| Facility | 26 | $45.71 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $288.40
| Professional | | $190.55 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $112.20
| Professional | 26 | $45.71 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $213.80
| Professional | TC | $147.91 | $147.91 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Facility | 26 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $190.55 / $977.24
| Professional | | $77.62 | $190.55 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $112.20 / $151.36
| Professional | 26 | $37.15 | $112.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $117.49 / $758.58
| Professional | TC | $54.95 | $117.49 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $257.04 / $489.78
| Professional | | $81.28 | $257.04 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $95.50 / $213.80
| Professional | 26 | $37.15 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $190.55 / $380.19
| Professional | TC | $54.95 | $190.55 | $380.19 |