- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $114.82 / $114.82
| Facility | 26 | $102.33 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $199.53 / $363.08
| Professional | | $165.96 | $199.53 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $223.87
| Professional | 26 | $95.50 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $125.89
| Professional | TC | $64.57 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $147.91 / $323.59
| Professional | | $63.10 | $147.91 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $117.49 / $165.96
| Facility | 26 | $25.12 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $275.42 / $812.83
| Professional | | $162.18 | $275.42 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $478.63
| Professional | 26 | $100.00 | $154.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $331.13
| Professional | TC | $66.07 | $112.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $354.81
| Professional | | $234.42 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $218.78
| Professional | 26 | $131.83 | $208.93 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $302.00
| Professional | | $144.54 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $169.82
| Professional | 26 | $85.11 | $120.23 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $131.83
| Professional | TC | $64.57 | $95.50 | $131.83 |