- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | 26 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $194.98
| Professional | | $64.57 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $125.89
| Professional | 26 | $33.11 | $42.66 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $45.71 / $87.10
| Professional | TC | $21.88 | $45.71 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $229.09
| Professional | | $72.44 | $87.10 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $134.90
| Professional | 26 | $37.15 | $52.48 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $109.65
| Professional | TC | $25.70 | $37.15 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | 26 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $186.21 / $269.15
| Professional | | $87.10 | $186.21 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $100.00 / $134.90
| Professional | 26 | $40.74 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $93.33 / $141.25
| Professional | TC | $46.77 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $316.23 / $380.19
| Professional | | $112.20 | $316.23 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $131.83 / $194.98
| Professional | 26 | $60.26 | $131.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $102.33 / $190.55
| Professional | TC | $38.02 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $218.78
| Professional | | $72.44 | $104.71 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $134.90
| Professional | 26 | $36.31 | $51.29 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $93.33
| Professional | TC | $25.70 | $37.15 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $165.96 / $239.88
| Professional | | $67.61 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $95.50 / $165.96
| Professional | 26 | $38.90 | $95.50 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $67.61 / $109.65
| Professional | TC | $22.91 | $67.61 | $109.65 |