- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $104.71
| Facility | 26 | $64.57 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $275.42 / $912.01
| Professional | | $107.15 | $275.42 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $245.47
| Professional | 26 | $61.66 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | 50 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $645.65
| Professional | TC | $165.96 | $302.00 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $223.87 / $467.74
| Professional | | $83.18 | $223.87 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $72.44 / $104.71
| Facility | 26 | $15.49 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $501.19 / $2,089.30
| Professional | | $186.21 | $501.19 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $91.20 / $316.23
| Professional | 26 | $51.29 | $91.20 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $436.52 / $1,584.89
| Professional | TC | $131.83 | $436.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $169.82
| Professional | 26 | $100.00 | $165.96 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $891.25
| Professional | | $199.53 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $75.86 / $131.83
| Professional | 26 | $39.81 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $316.23 / $776.25
| Professional | TC | $144.54 | $316.23 | $776.25 |