- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $194.98 / $288.40
| Facility | 26 | $37.15 | $194.98 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $144.54
| Professional | | $48.98 | $70.79 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $77.62
| Professional | 26 | $28.18 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $63.10
| Professional | TC | $16.98 | $34.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $83.18 / $190.55
| Professional | | $56.23 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $100.00
| Professional | 26 | $30.20 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $87.10
| Professional | TC | $22.39 | $39.81 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $138.04
| Professional | | $69.18 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $64.57
| Professional | 26 | $30.90 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $74.13
| Professional | TC | $38.90 | $57.54 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $63.10 / $131.83
| Professional | | $47.86 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $77.62
| Professional | 26 | $26.92 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $67.61
| Professional | TC | $24.55 | $30.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $138.04
| Professional | | $46.77 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $36.31 / $75.86
| Professional | 26 | $23.44 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $74.13
| Professional | TC | $19.50 | $33.88 | $74.13 |