- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $81.28 / $218.78
| Facility | 26 | $45.71 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $295.12
| Professional | | $75.86 | $107.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $151.36
| Professional | 26 | $40.74 | $58.88 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $114.82
| Professional | TC | $34.67 | $53.70 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $309.03
| Professional | | $87.10 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $63.10 / $117.49
| Professional | 26 | $45.71 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $72.44 / $208.93
| Professional | TC | $40.74 | $72.44 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $74.13 / $245.47
| Facility | 26 | $12.30 | $74.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $288.40
| Professional | | $87.10 | $154.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $74.13 / $141.25
| Professional | 26 | $45.71 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $77.62 / $177.83
| Professional | TC | $41.69 | $77.62 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $245.47
| Professional | | $85.11 | $128.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $123.03
| Professional | 26 | $41.69 | $61.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $144.54
| Professional | TC | $38.90 | $63.10 | $144.54 |