- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $144.54
| Facility | 26 | $95.50 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $371.54 / $602.56
| Professional | | $234.42 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $144.54
| Professional | 26 | $57.54 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $501.19
| Professional | TC | $173.78 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $478.63 / $912.01
| Professional | | $223.87 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $91.20 / $123.03
| Professional | 26 | $47.86 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $398.11 / $794.33
| Professional | TC | $165.96 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $128.82
| Professional | | $32.36 | $33.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $912.01
| Professional | | $229.09 | $338.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $123.03
| Professional | 26 | $46.77 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $281.84 / $776.25
| Professional | TC | $169.82 | $281.84 | $776.25 |