- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | 26 | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $436.52
| Professional | | $234.42 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $87.10
| Professional | 26 | $33.88 | $39.81 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $239.88 / $380.19
| Professional | TC | $199.53 | $239.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $316.23 / $588.84
| Professional | | $245.47 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $77.62
| Professional | 26 | $35.48 | $46.77 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $501.19
| Professional | TC | $208.93 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $338.84 / $575.44
| Professional | | $275.42 | $338.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $83.18
| Professional | 26 | $40.74 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $501.19
| Professional | TC | $234.42 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $707.95
| Professional | | $295.12 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $58.88 / $104.71
| Professional | 26 | $43.65 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $602.56
| Professional | TC | $251.19 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $457.09
| Professional | | $234.42 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $66.07
| Professional | 26 | $34.67 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $245.47 / $389.05
| Professional | TC | $204.17 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $371.54 / $707.95
| Professional | | $245.47 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $100.00
| Professional | 26 | $37.15 | $54.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $316.23 / $602.56
| Professional | TC | $213.80 | $316.23 | $602.56 |