- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $275.42
| Facility | 26 | $60.26 | $104.71 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $630.96
| Professional | | $177.83 | $275.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $154.88
| Professional | 26 | $54.95 | $72.44 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $371.54
| Professional | TC | $120.23 | $177.83 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Facility | 26 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $630.96
| Professional | | $181.97 | $316.23 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $154.88
| Professional | 26 | $58.88 | $85.11 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $478.63
| Professional | TC | $125.89 | $229.09 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $77.62 / $213.80
| Facility | 26 | $14.45 | $77.62 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $354.81 / $630.96
| Professional | | $173.78 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $87.10 / $169.82
| Professional | 26 | $50.12 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $251.19 / $489.78
| Professional | TC | $120.23 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $288.40 / $645.65
| Professional | | $158.49 | $288.40 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $239.88
| Professional | 26 | $54.95 | $79.43 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $416.87
| Professional | TC | $120.23 | $194.98 | $416.87 |