- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $42.66 / $47.86
| Facility | 26 | $38.02 | $42.66 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $416.87
| Professional | | $173.78 | $269.15 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $54.95 / $83.18
| Professional | 26 | $33.88 | $54.95 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $177.83 / $269.15
| Professional | TC | $138.04 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $147.91 / $323.59
| Professional | | $38.02 | $147.91 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $42.66 / $61.66
| Facility | 26 | $9.12 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $870.96
| Professional | | $173.78 | $263.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $173.78
| Professional | 26 | $34.67 | $50.12 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $724.44
| Professional | TC | $138.04 | $213.80 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $501.19
| Professional | | $323.59 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $100.00
| Professional | 26 | $61.66 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $275.42 / $281.84
| Professional | TC | $263.03 | $275.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $426.58
| Professional | | $162.18 | $229.09 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $63.10
| Professional | 26 | $28.18 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $380.19
| Professional | TC | $125.89 | $194.98 | $380.19 |