- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $102.33 / $251.19
| Facility | 26 | $34.67 | $102.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $794.33
| Professional | | $190.55 | $269.15 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $53.70 / $128.82
| Professional | 26 | $25.70 | $53.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $758.58
| Professional | TC | $144.54 | $218.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $630.96 / $977.24
| Professional | | $41.69 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $1,380.38
| Professional | | $239.88 | $346.74 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $66.07 / $177.83
| Professional | 26 | $33.88 | $66.07 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $1,202.26
| Professional | TC | $208.93 | $281.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $331.13 / $645.65
| Professional | | $288.40 | $331.13 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $87.10
| Professional | 26 | $39.81 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $288.40 / $575.44
| Professional | TC | $245.47 | $288.40 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $446.68 / $954.99
| Professional | | $204.17 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $131.83
| Professional | 26 | $32.36 | $57.54 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $389.05 / $831.76
| Professional | TC | $169.82 | $389.05 | $831.76 |