- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $154.88
| Facility | 26 | $93.33 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $446.68 / $1,071.52
| Professional | | $194.98 | $446.68 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $190.55 / $501.19
| Professional | 26 | $95.50 | $190.55 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $371.54 / $870.96
| Professional | TC | $234.42 | $371.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $239.88 / $295.12
| Professional | | $234.42 | $239.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $128.82
| Professional | 26 | $75.86 | $114.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $489.78 / $575.44
| Professional | | $177.83 | $489.78 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $245.47
| Professional | 26 | $131.83 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $302.00 / $354.81
| Professional | TC | $109.65 | $302.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $1,174.90
| Professional | | $338.84 | $602.56 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $269.15
| Professional | 26 | $87.10 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $457.09 / $977.24
| Professional | TC | $257.04 | $457.09 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $436.52 / $1,230.27
| Professional | | $295.12 | $436.52 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $204.17
| Professional | 26 | $83.18 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $1,071.52
| Professional | TC | $208.93 | $309.03 | $1,071.52 |