- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $138.04
| Facility | 26 | $85.11 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $1,000.00
| Professional | | $239.88 | $323.59 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $257.04
| Professional | 26 | $74.13 | $112.20 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $363.08
| Professional | TC | $158.49 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $275.42 / $588.84
| Professional | | $107.15 | $275.42 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $93.33 / $134.90
| Facility | 26 | $19.95 | $93.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $537.03 / $2,089.30
| Professional | | $229.09 | $537.03 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $117.49 / $426.58
| Professional | 26 | $66.07 | $117.49 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $416.87 / $1,819.70
| Professional | TC | $158.49 | $416.87 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $223.87
| Professional | 26 | $131.83 | $204.17 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | TC | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $457.09 / $977.24
| Professional | | $234.42 | $457.09 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $97.72 / $169.82
| Professional | 26 | $52.48 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $346.74 / $851.14
| Professional | TC | $158.49 | $346.74 | $851.14 |