- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $194.98 / $251.19
| Facility | 26 | $181.97 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $302.00 / $588.84
| Professional | | $239.88 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $162.18 / $407.38
| Professional | 26 | $131.83 | $162.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $208.93
| Professional | TC | $107.15 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $234.42
| Professional | 26 | $117.49 | $181.97 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $407.38 / $645.65
| Professional | | $223.87 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $218.78 / $338.84
| Professional | 26 | $123.03 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $295.12
| Professional | TC | $100.00 | $186.21 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $575.44
| Professional | | $269.15 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $257.04
| Professional | 26 | $151.36 | $194.98 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $239.88
| Professional | TC | $125.89 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $602.56
| Professional | | $257.04 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $323.59
| Professional | 26 | $138.04 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $154.88 / $275.42
| Professional | TC | $120.23 | $154.88 | $275.42 |