- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $169.82 / $416.87
| Facility | 26 | $89.13 | $169.82 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $933.25
| Professional | | $281.84 | $436.52 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $131.83 / $275.42
| Professional | 26 | $85.11 | $131.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $588.84
| Professional | TC | $194.98 | $309.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $977.24
| Professional | | $275.42 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $213.80
| Professional | 26 | $83.18 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $794.33
| Professional | TC | $199.53 | $338.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $112.20 / $302.00
| Facility | 26 | $20.89 | $112.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $537.03 / $1,023.29
| Professional | | $269.15 | $537.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $123.03 / $239.88
| Professional | 26 | $70.79 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $380.19 / $794.33
| Professional | TC | $190.55 | $380.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $891.25
| Professional | | $275.42 | $436.52 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $426.58
| Professional | 26 | $75.86 | $107.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $309.03 / $707.95
| Professional | TC | $194.98 | $309.03 | $707.95 |