- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $134.90
| Facility | 26 | $97.72 | $123.03 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $165.96
| Professional | | $69.18 | $89.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $114.82
| Professional | TC | $46.77 | $61.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $91.20 / $371.54
| Professional | | $75.86 | $91.20 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $263.03
| Professional | TC | $54.95 | $64.57 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $44.67
| Facility | 26 | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $204.17
| Professional | | $75.86 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $141.25
| Professional | TC | $50.12 | $83.18 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $123.03
| Facility | 26 | $64.57 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $676.08
| Professional | | $91.20 | $120.23 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $512.86
| Professional | TC | $60.26 | $89.13 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $181.97
| Professional | | $85.11 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $128.82
| Professional | TC | $58.88 | $81.28 | $128.82 |