- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $75.86
| Facility | 26 | $48.98 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $549.54
| Professional | | $154.88 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $100.00 / $223.87
| Professional | 26 | $51.29 | $100.00 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $389.05
| Professional | TC | $100.00 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $54.95 / $79.43
| Professional | 26 | $38.90 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $251.19 / $295.12
| Professional | | $91.20 | $251.19 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $128.82
| Professional | 26 | $70.79 | $100.00 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $151.36 / $177.83
| Professional | TC | $54.95 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $489.78
| Professional | | $144.54 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $141.25
| Professional | 26 | $52.48 | $83.18 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $194.98 / $338.84
| Professional | TC | $95.50 | $194.98 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $407.38
| Professional | | $123.03 | $186.21 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $120.23
| Professional | 26 | $43.65 | $60.26 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $309.03
| Professional | TC | $83.18 | $120.23 | $309.03 |