- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $87.10 / $95.50
| Facility | 26 | $85.11 | $87.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $436.52
| Professional | | $177.83 | $218.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $177.83
| Professional | 26 | $75.86 | $87.10 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $239.88
| Professional | TC | $100.00 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $398.11
| Professional | | $93.33 | $186.21 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $134.90
| Facility | 26 | $19.95 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $870.96
| Professional | | $144.54 | $263.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $117.49 / $380.19
| Professional | 26 | $66.07 | $117.49 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $489.78
| Professional | TC | $83.18 | $147.91 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $141.25 / $218.78
| Professional | 26 | $131.83 | $141.25 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $194.98
| Professional | TC | $190.55 | $190.55 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $229.09 / $446.68
| Professional | | $109.65 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $169.82
| Professional | 26 | $52.48 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $141.25 / $239.88
| Professional | TC | $74.13 | $141.25 | $239.88 |