- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $107.15
| Facility | 26 | $61.66 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $446.68
| Professional | | $190.55 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $128.82
| Professional | 26 | $54.95 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $173.78 / $338.84
| Professional | TC | $134.90 | $173.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $56.23
| Professional | 26 | $54.95 | $54.95 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $346.74 / $537.03
| Professional | | $251.19 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $128.82
| Professional | 26 | $64.57 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $407.38
| Professional | TC | $190.55 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $380.19 / $691.83
| Professional | | $194.98 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $141.25
| Professional | 26 | $52.48 | $81.28 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $288.40 / $575.44
| Professional | TC | $138.04 | $288.40 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $562.34
| Professional | | $204.17 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $123.03
| Professional | 26 | $53.70 | $66.07 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $229.09 / $457.09
| Professional | TC | $147.91 | $229.09 | $457.09 |