- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $194.98 / $288.40
| Facility | 26 | $39.81 | $194.98 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $199.53 / $724.44
| Professional | | $154.88 | $199.53 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $158.49
| Professional | 26 | $30.20 | $42.66 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $562.34
| Professional | TC | $123.03 | $158.49 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $891.25 / $1,174.90
| Professional | | $47.86 | $891.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | TC | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $446.68 / $1,047.13
| Professional | | $186.21 | $446.68 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $75.86 / $204.17
| Professional | 26 | $38.02 | $75.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $371.54 / $851.14
| Professional | TC | $147.91 | $371.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $501.19
| Professional | | $229.09 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $53.70 / $100.00
| Professional | 26 | $45.71 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $208.93 / $398.11
| Professional | TC | $181.97 | $208.93 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $741.31
| Professional | | $213.80 | $338.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $147.91
| Professional | 26 | $38.02 | $64.57 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $602.56
| Professional | TC | $177.83 | $269.15 | $602.56 |