- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $446.68
| Facility | 26 | $97.72 | $158.49 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $194.98 / $707.95
| Professional | | $117.49 | $194.98 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $371.54
| Professional | 26 | $91.20 | $147.91 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $44.67 / $162.18
| Professional | TC | $22.91 | $44.67 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $257.04 / $691.83
| Professional | | $125.89 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $263.03
| Professional | 26 | $97.72 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $81.28 / $489.78
| Professional | TC | $28.84 | $81.28 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $158.49 / $524.81
| Facility | 26 | $26.30 | $158.49 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $257.04 / $616.60
| Professional | | $134.90 | $257.04 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $309.03
| Professional | 26 | $97.72 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $74.13 / $407.38
| Professional | TC | $31.62 | $74.13 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $501.19
| Professional | | $123.03 | $208.93 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $263.03
| Professional | 26 | $89.13 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $323.59
| Professional | TC | $25.12 | $50.12 | $323.59 |