- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $234.42
| Facility | 26 | $57.54 | $87.10 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $549.54
| Professional | | $169.82 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $204.17
| Professional | 26 | $52.48 | $79.43 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $380.19
| Professional | TC | $112.20 | $173.78 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Facility | 26 | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $295.12 / $575.44
| Professional | | $181.97 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $141.25
| Professional | 26 | $54.95 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $446.68
| Professional | TC | $131.83 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $74.13 / $204.17
| Facility | 26 | $14.13 | $74.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $323.59 / $575.44
| Professional | | $165.96 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $158.49
| Professional | 26 | $46.77 | $79.43 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $223.87 / $436.52
| Professional | TC | $114.82 | $223.87 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $257.04 / $501.19
| Professional | | $169.82 | $257.04 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $239.88
| Professional | 26 | $50.12 | $74.13 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $380.19
| Professional | TC | $114.82 | $186.21 | $380.19 |