- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $275.42
| Facility | 26 | $151.36 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $218.78 / $588.84
| Professional | | $154.88 | $218.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $288.40 / $954.99
| Professional | 26 | $89.13 | $288.40 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $302.00
| Professional | TC | $67.61 | $120.23 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $338.84
| Professional | | $165.96 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $223.87
| Professional | 26 | $81.28 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $89.13 / $120.23
| Professional | TC | $83.18 | $89.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $416.87
| Professional | | $117.49 | $281.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $177.83 / $208.93
| Professional | 26 | $66.07 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $117.49 / $229.09
| Professional | TC | $46.77 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $251.19 / $338.84
| Professional | | $128.82 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $138.04 / $190.55
| Professional | 26 | $77.62 | $138.04 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $112.20 / $158.49
| Professional | TC | $50.12 | $112.20 | $158.49 |