- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $85.11 / $85.11
| Facility | 26 | $77.62 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $154.88 / $275.42
| Professional | | $125.89 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $169.82
| Professional | 26 | $72.44 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $97.72
| Professional | TC | $51.29 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $117.49 / $245.47
| Professional | | $48.98 | $117.49 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $87.10 / $125.89
| Facility | 26 | $19.05 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $616.60
| Professional | | $123.03 | $208.93 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $363.08
| Professional | 26 | $74.13 | $117.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $257.04
| Professional | TC | $51.29 | $87.10 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $169.82 / $275.42
| Professional | | $162.18 | $169.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $162.18
| Professional | 26 | $107.15 | $154.88 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $229.09
| Professional | | $109.65 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $128.82
| Professional | 26 | $63.10 | $93.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $102.33
| Professional | TC | $51.29 | $74.13 | $102.33 |