- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $58.88 / $144.54
| Facility | 26 | $19.95 | $58.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $208.93 / $338.84
| Professional | | $162.18 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $31.62 / $56.23
| Professional | 26 | $16.98 | $31.62 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $309.03
| Professional | TC | $147.91 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $724.44 / $933.25
| Professional | | $24.55 | $724.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | TC | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $1,122.02
| Professional | | $194.98 | $389.05 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $102.33
| Professional | 26 | $19.50 | $34.67 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $354.81 / $1,023.29
| Professional | TC | $177.83 | $354.81 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $269.15 / $524.81
| Professional | | $234.42 | $269.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $50.12
| Professional | 26 | $23.44 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $478.63
| Professional | TC | $208.93 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $363.08 / $776.25
| Professional | | $218.78 | $363.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $33.11 / $75.86
| Professional | 26 | $19.05 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $323.59 / $707.95
| Professional | TC | $194.98 | $323.59 | $707.95 |