- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $138.04
| Facility | 26 | $100.00 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $831.76
| Professional | | $275.42 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $234.42
| Professional | 26 | $85.11 | $123.03 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $478.63
| Professional | TC | $190.55 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $79.43
| Professional | 26 | $77.62 | $77.62 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $724.44
| Professional | | $331.13 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $114.82 / $177.83
| Professional | 26 | $91.20 | $114.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $331.13 / $537.03
| Professional | TC | $234.42 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $562.34 / $1,047.13
| Professional | | $269.15 | $562.34 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $204.17
| Professional | 26 | $74.13 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $398.11 / $870.96
| Professional | TC | $190.55 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $870.96
| Professional | | $269.15 | $416.87 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $199.53
| Professional | 26 | $77.62 | $95.50 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $691.83
| Professional | TC | $190.55 | $288.40 | $691.83 |