- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $104.71
| Facility | 26 | $72.44 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $141.25
| Professional | | $85.11 | $107.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $190.55
| Professional | 26 | $52.48 | $75.86 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $47.86
| Professional | TC | $26.92 | $37.15 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $158.49
| Professional | | $53.70 | $81.28 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $147.91
| Professional | | $89.13 | $109.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $97.72
| Professional | 26 | $58.88 | $74.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $52.48
| Professional | TC | $29.51 | $38.02 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $245.47
| Professional | | $89.13 | $134.90 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $97.72
| Professional | 26 | $60.26 | $79.43 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $52.48
| Professional | TC | $29.51 | $38.02 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $173.78
| Professional | | $54.95 | $57.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $123.03
| Professional | 26 | $35.48 | $38.90 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $51.29
| Professional | TC | $15.85 | $20.89 | $51.29 |