- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $50.12
| Facility | 26 | $43.65 | $43.65 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $173.78
| Professional | | $66.07 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $120.23
| Professional | 26 | $38.02 | $51.29 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $38.90 / $75.86
| Professional | TC | $23.44 | $38.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $75.86 / $87.10
| Professional | | $69.18 | $75.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $134.90
| Professional | | $63.10 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $77.62
| Professional | 26 | $42.66 | $51.29 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.12 / $53.70
| Professional | TC | $20.42 | $25.12 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $125.89
| Professional | | $75.86 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $74.13
| Professional | 26 | $40.74 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $58.88
| Professional | TC | $28.84 | $39.81 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $173.78
| Professional | | $70.79 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $95.50
| Professional | 26 | $40.74 | $58.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $64.57
| Professional | TC | $23.99 | $38.90 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $190.55
| Facility | 26 | $95.50 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $616.60
| Professional | | $64.57 | $100.00 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $263.03
| Professional | 26 | $39.81 | $61.66 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $263.03
| Professional | TC | $22.91 | $38.02 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $147.91
| Professional | | $60.26 | $85.11 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $89.13
| Professional | 26 | $37.15 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $64.57
| Professional | TC | $20.89 | $33.88 | $64.57 |