- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $21.88 / $37.15
| Facility | 26 | $19.50 | $21.88 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $131.83 / $199.53
| Professional | | $112.20 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $46.77
| Professional | 26 | $18.62 | $23.99 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $107.15 / $169.82
| Professional | TC | $89.13 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Professional | 26 | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $120.23 / $162.18
| Professional | | $23.99 | $120.23 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $30.20
| Facility | 26 | $25.12 | $25.12 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $165.96 / $229.09
| Professional | | $123.03 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $38.90
| Professional | 26 | $21.38 | $26.92 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $204.17
| Professional | TC | $102.33 | $147.91 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $173.78 / $173.78
| Facility | 26 | $53.70 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $1,047.13
| Professional | | $114.82 | $162.18 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $302.00
| Professional | 26 | $20.89 | $26.92 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $912.01
| Professional | TC | $89.13 | $141.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $138.04 / $223.87
| Professional | | $104.71 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $39.81
| Professional | 26 | $19.95 | $25.12 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $190.55
| Professional | TC | $85.11 | $109.65 | $190.55 |