- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $131.83
| Facility | 26 | $53.70 | $74.13 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $457.09 / $1,047.13
| Professional | | $338.84 | $457.09 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $199.53
| Professional | 26 | $51.29 | $72.44 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $389.05 / $676.08
| Professional | TC | $288.40 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $436.52 / $831.76
| Professional | | $173.78 | $436.52 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $138.04
| Professional | 26 | $50.12 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $371.54 / $741.31
| Professional | TC | $123.03 | $371.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $72.44 / $204.17
| Facility | 26 | $13.49 | $72.44 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $575.44 / $1,348.96
| Professional | | $239.88 | $575.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $169.82
| Professional | 26 | $54.95 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $501.19 / $1,174.90
| Professional | TC | $186.21 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $489.78 / $1,047.13
| Professional | | $229.09 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $144.54
| Professional | 26 | $48.98 | $72.44 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $416.87 / $891.25
| Professional | TC | $186.21 | $416.87 | $891.25 |