- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $125.89
| Facility | 26 | $67.61 | $97.72 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $1,445.44
| Professional | | $269.15 | $426.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $239.88
| Professional | 26 | $67.61 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $309.03 / $562.34
| Professional | TC | $204.17 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $380.19 / $724.44
| Professional | | $354.81 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $123.03
| Professional | 26 | $69.18 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $288.40 / $562.34
| Professional | TC | $275.42 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $102.33
| Professional | | $63.10 | $87.10 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $112.20
| Facility | 26 | $16.98 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $660.69 / $2,137.96
| Professional | | $363.08 | $660.69 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $112.20 / $338.84
| Professional | 26 | $63.10 | $112.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $549.54 / $1,737.80
| Professional | TC | $295.12 | $549.54 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $316.23
| Professional | | $32.36 | $33.11 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $741.31
| Professional | | $346.74 | $478.63 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $125.89
| Professional | 26 | $64.57 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $588.84
| Professional | TC | $275.42 | $398.11 | $588.84 |