- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $263.03 / $660.69
| Facility | 26 | $91.20 | $263.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $1,230.27
| Professional | | $288.40 | $467.74 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $295.12
| Professional | 26 | $83.18 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $562.34
| Professional | TC | $218.78 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $512.86 / $4,365.16
| Professional | | $120.23 | $512.86 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $134.90
| Professional | 26 | $114.82 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $407.38 / $416.87
| Professional | TC | $363.08 | $407.38 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $645.65 / $1,230.27
| Professional | | $426.58 | $645.65 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $288.40
| Professional | 26 | $81.28 | $128.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $1,000.00
| Professional | TC | $331.13 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $933.25
| Professional | | $371.54 | $436.52 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $229.09
| Professional | 26 | $93.33 | $109.65 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $323.59 / $691.83
| Professional | TC | $275.42 | $323.59 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $489.78 / $3,090.30
| Professional | | $95.50 | $489.78 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $218.78 / $645.65
| Professional | 26 | $95.50 | $218.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $1,096.48
| Professional | TC | $257.04 | $426.58 | $1,096.48 |