- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $100.00
| Facility | 26 | $57.54 | $89.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $338.84 / $630.96
| Professional | | $234.42 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $81.28 / $154.88
| Professional | 26 | $57.54 | $81.28 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $501.19
| Professional | TC | $173.78 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $660.69
| Professional | | $323.59 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $77.62 / $123.03
| Professional | 26 | $60.26 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $537.03
| Professional | TC | $257.04 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $501.19 / $912.01
| Professional | | $229.09 | $501.19 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $151.36
| Professional | 26 | $48.98 | $75.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $371.54 / $794.33
| Professional | TC | $169.82 | $371.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $724.44
| Professional | | $218.78 | $398.11 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $125.89
| Professional | 26 | $50.12 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $630.96
| Professional | TC | $169.82 | $316.23 | $630.96 |