- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $190.55
| Facility | 26 | $138.04 | $173.78 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $208.93
| Professional | | $72.44 | $104.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $134.90
| Professional | TC | $46.77 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $186.21
| Professional | | $93.33 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $123.03
| Professional | TC | $61.66 | $77.62 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $45.71 / $64.57
| Facility | 26 | $9.77 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $245.47
| Professional | | $83.18 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $93.33 / $173.78
| Professional | TC | $50.12 | $93.33 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $181.97 / $181.97
| Facility | 26 | $93.33 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $1,122.02
| Professional | | $93.33 | $147.91 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $104.71 / $912.01
| Professional | TC | $53.70 | $104.71 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $204.17
| Professional | | $93.33 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $144.54
| Professional | TC | $54.95 | $81.28 | $144.54 |