- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $89.13
| Facility | 26 | $41.69 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $512.86
| Professional | | $117.49 | $186.21 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $83.18 / $95.50
| Professional | 26 | $38.02 | $83.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $173.78 / $239.88
| Professional | TC | $87.10 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $123.03 / $269.15
| Professional | | $53.70 | $123.03 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $46.77 / $66.07
| Facility | 26 | $10.00 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $257.04 / $1,047.13
| Professional | | $107.15 | $257.04 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $64.57 / $269.15
| Professional | 26 | $32.36 | $64.57 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $190.55 / $724.44
| Professional | TC | $72.44 | $190.55 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $109.65
| Professional | 26 | $64.57 | $107.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $162.18 / $169.82
| Professional | TC | $147.91 | $162.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $223.87 / $436.52
| Professional | | $100.00 | $223.87 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $63.10 / $95.50
| Professional | 26 | $27.54 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $158.49 / $338.84
| Professional | TC | $72.44 | $158.49 | $338.84 |