- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $218.78
| Facility | 26 | $54.95 | $77.62 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $954.99
| Professional | | $144.54 | $275.42 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $213.80
| Professional | 26 | $50.12 | $63.10 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $436.52
| Professional | TC | $102.33 | $177.83 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $575.44
| Professional | | $169.82 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $141.25
| Professional | 26 | $54.95 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $218.78 / $446.68
| Professional | TC | $120.23 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $72.44 / $194.98
| Facility | 26 | $13.49 | $72.44 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $316.23 / $575.44
| Professional | | $165.96 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $158.49
| Professional | 26 | $45.71 | $79.43 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $426.58
| Professional | TC | $112.20 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $776.25
| Professional | | $158.49 | $269.15 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $295.12
| Professional | 26 | $51.29 | $77.62 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $190.55 / $512.86
| Professional | TC | $107.15 | $190.55 | $512.86 |