- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $128.82
| Facility | 26 | $72.44 | $97.72 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $245.47 / $478.63
| Professional | | $158.49 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $204.17
| Professional | 26 | $56.23 | $91.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $281.84
| Professional | TC | $97.72 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $323.59
| Professional | | $229.09 | $229.09 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $141.25
| Professional | 26 | $56.23 | $56.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $331.13 / $549.54
| Professional | | $158.49 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $123.03
| Professional | 26 | $51.29 | $93.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $251.19 / $426.58
| Professional | TC | $95.50 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $75.86
| Professional | | $32.36 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $229.09 / $478.63
| Professional | | $173.78 | $229.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $70.79 / $125.89
| Professional | 26 | $51.29 | $70.79 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $346.74
| Professional | TC | $117.49 | $154.88 | $346.74 |