- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $79.43
| Facility | 26 | $38.90 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $134.90
| Professional | | $58.88 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $75.86
| Professional | 26 | $33.11 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $57.54
| Professional | TC | $21.88 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $131.83
| Professional | | $66.07 | $83.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $43.65 / $79.43
| Professional | 26 | $31.62 | $43.65 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $87.10 / $144.54
| Professional | | $17.38 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $95.50
| Professional | 26 | $45.71 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $35.48 / $72.44
| Professional | TC | $21.38 | $35.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $40.74 / $57.54
| Facility | 26 | $8.71 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $144.54
| Professional | | $66.07 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $87.10
| Professional | 26 | $36.31 | $54.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $69.18
| Professional | TC | $21.88 | $32.36 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 26 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $588.84 / $588.84
| Professional | | $562.34 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $281.84 / $281.84
| Professional | 26 | $251.19 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $302.00
| Professional | TC | $245.47 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $125.89
| Professional | | $57.54 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $81.28
| Professional | 26 | $33.88 | $48.98 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $48.98
| Professional | TC | $19.95 | $28.18 | $48.98 |