- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $275.42
| Facility | 26 | $60.26 | $91.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $346.74 / $977.24
| Professional | | $204.17 | $346.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $109.65 / $288.40
| Professional | 26 | $57.54 | $109.65 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $398.11
| Professional | TC | $144.54 | $181.97 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Facility | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $537.03
| Professional | | $204.17 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $162.18
| Professional | 26 | $60.26 | $89.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $204.17 / $380.19
| Professional | TC | $141.25 | $204.17 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $79.43 / $213.80
| Facility | 26 | $14.79 | $79.43 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $645.65
| Professional | | $218.78 | $309.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $177.83
| Professional | 26 | $63.10 | $91.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $467.74
| Professional | TC | $154.88 | $223.87 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $524.81
| Professional | | $199.53 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $147.91
| Professional | 26 | $56.23 | $79.43 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $199.53 / $380.19
| Professional | TC | $144.54 | $199.53 | $380.19 |