- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | 26 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $112.20 / $338.84
| Professional | | $69.18 | $112.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $72.44
| Professional | 26 | $30.90 | $36.31 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $67.61 / $125.89
| Professional | TC | $33.11 | $67.61 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $229.09
| Professional | | $72.44 | $112.20 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $77.62
| Professional | 26 | $39.81 | $47.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $63.10 / $134.90
| Professional | TC | $29.51 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $125.89
| Professional | | $32.36 | $33.11 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | 26 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $213.80
| Professional | | $102.33 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $74.13
| Professional | 26 | $33.11 | $47.86 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $85.11 / $114.82
| Professional | TC | $69.18 | $85.11 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $223.87
| Professional | | $100.00 | $162.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $87.10
| Professional | 26 | $33.11 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $125.89
| Professional | TC | $66.07 | $107.15 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $95.50 / $186.21
| Professional | | $43.65 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $158.49
| Professional | | $60.26 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $39.81 / $60.26
| Professional | 26 | $30.20 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $60.26 / $97.72
| Professional | TC | $25.12 | $60.26 | $97.72 |