- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $204.17 / $549.54
| Facility | 26 | $77.62 | $204.17 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $1,023.29
| Professional | | $275.42 | $389.05 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $251.19
| Professional | 26 | $74.13 | $93.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $616.60
| Professional | TC | $213.80 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $436.52 / $3,715.35
| Professional | | $288.40 | $436.52 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $100.00 / $112.20
| Professional | 26 | $97.72 | $100.00 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $323.59 / $323.59
| Professional | TC | $288.40 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $891.25
| Professional | | $281.84 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $239.88
| Professional | 26 | $67.61 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $316.23 / $660.69
| Professional | TC | $204.17 | $316.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $741.31
| Professional | | $295.12 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $190.55
| Professional | 26 | $77.62 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $257.04 / $549.54
| Professional | TC | $218.78 | $257.04 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $512.86 / $2,137.96
| Professional | | $95.50 | $512.86 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $281.84 / $537.03
| Professional | 26 | $77.62 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $295.12 / $1,621.81
| Professional | TC | $95.50 | $295.12 | $1,621.81 |