- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | 26 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $131.83
| Professional | | $69.18 | $83.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $44.67 / $125.89
| Professional | 26 | $37.15 | $44.67 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $61.66
| Professional | TC | $26.30 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $165.96
| Professional | | $79.43 | $100.00 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $100.00
| Professional | 26 | $41.69 | $63.10 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $44.67 / $72.44
| Professional | TC | $29.51 | $44.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $93.33
| Professional | | $32.36 | $33.11 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | 26 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $177.83
| Professional | | $123.03 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $295.12
| Professional | 26 | $64.57 | $85.11 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $91.20
| Professional | TC | $46.77 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $154.88
| Professional | | $79.43 | $125.89 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $102.33
| Professional | 26 | $39.81 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $57.54 / $66.07
| Professional | TC | $38.90 | $57.54 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $66.07 / $147.91
| Professional | | $45.71 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $125.89
| Professional | | $64.57 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $70.79
| Professional | 26 | $36.31 | $50.12 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $56.23
| Professional | TC | $23.99 | $33.88 | $56.23 |