- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $109.65
| Facility | 26 | $61.66 | $97.72 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $389.05
| Professional | | $131.83 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $144.54
| Professional | 26 | $47.86 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $125.89 / $275.42
| Professional | TC | $81.28 | $125.89 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $53.70 / $117.49
| Professional | 26 | $46.77 | $53.70 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $162.18
| Professional | TC | $79.43 | $79.43 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $239.88 / $426.58
| Professional | | $112.20 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $79.43 / $104.71
| Professional | 26 | $43.65 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $158.49 / $331.13
| Professional | TC | $69.18 | $158.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $63.10
| Professional | | $32.36 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $446.68
| Professional | | $120.23 | $177.83 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $107.15
| Professional | 26 | $42.66 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $346.74
| Professional | TC | $74.13 | $109.65 | $346.74 |