- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $97.72
| Facility | 26 | $75.86 | $89.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $245.47 / $489.78
| Professional | | $169.82 | $245.47 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $97.72
| Professional | 26 | $51.29 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $436.52
| Professional | TC | $120.23 | $177.83 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $251.19 / $323.59
| Professional | | $218.78 | $251.19 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $74.13 / $95.50
| Professional | 26 | $64.57 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $177.83 / $229.09
| Professional | TC | $154.88 | $177.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $323.59 / $812.83
| Professional | | $199.53 | $323.59 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $123.03
| Professional | 26 | $53.70 | $83.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $251.19 / $724.44
| Professional | TC | $141.25 | $251.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $389.05 / $645.65
| Professional | | $204.17 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $120.23
| Professional | 26 | $56.23 | $72.44 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $588.84
| Professional | TC | $144.54 | $269.15 | $588.84 |