- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $398.11
| Facility | 26 | $83.18 | $158.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $724.44
| Professional | | $239.88 | $323.59 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $213.80
| Professional | 26 | $66.07 | $91.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $478.63
| Professional | TC | $158.49 | $218.78 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $870.96
| Professional | | $257.04 | $389.05 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $204.17
| Professional | 26 | $72.44 | $100.00 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $660.69
| Professional | TC | $190.55 | $281.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $109.65 / $295.12
| Facility | 26 | $20.89 | $109.65 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $489.78 / $933.25
| Professional | | $263.03 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $229.09
| Professional | 26 | $69.18 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $371.54 / $724.44
| Professional | TC | $190.55 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $794.33
| Professional | | $275.42 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $199.53
| Professional | 26 | $74.13 | $102.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $616.60
| Professional | TC | $199.53 | $309.03 | $616.60 |