- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $128.82
| Facility | 26 | $79.43 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $851.14
| Professional | | $275.42 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $281.84
| Professional | 26 | $85.11 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $602.56
| Professional | TC | $194.98 | $316.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $478.63 / $575.44
| Professional | | $177.83 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $199.53
| Professional | 26 | $109.65 | $154.88 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $331.13 / $389.05
| Professional | TC | $120.23 | $331.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $489.78 / $933.25
| Professional | | $263.03 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $223.87
| Professional | 26 | $83.18 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $676.08
| Professional | TC | $190.55 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $812.83
| Professional | | $239.88 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $181.97
| Professional | 26 | $69.18 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $245.47 / $691.83
| Professional | TC | $169.82 | $245.47 | $691.83 |