- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $75.86 / $107.15
| Facility | 26 | $67.61 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $269.15 / $549.54
| Professional | | $181.97 | $269.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $173.78
| Professional | 26 | $60.26 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $398.11
| Professional | TC | $117.49 | $186.21 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $169.82 / $389.05
| Professional | | $85.11 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $74.13 / $107.15
| Facility | 26 | $15.85 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $363.08 / $1,258.93
| Professional | | $154.88 | $363.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $323.59
| Professional | 26 | $52.48 | $93.33 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $245.47 / $851.14
| Professional | TC | $97.72 | $245.47 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $173.78
| Professional | 26 | $104.71 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $223.87
| Professional | TC | $208.93 | $208.93 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $281.84 / $524.81
| Professional | | $138.04 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $79.43 / $134.90
| Professional | 26 | $40.74 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $213.80 / $407.38
| Professional | TC | $95.50 | $213.80 | $407.38 |