- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $416.87 / $489.78
| Facility | 26 | $186.21 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $549.54 / $2,570.40
| Professional | | $346.74 | $549.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $371.54
| Professional | 26 | $95.50 | $151.36 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $1,096.48
| Professional | TC | $239.88 | $338.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $870.96 / $1,621.81
| Professional | | $371.54 | $870.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $281.84
| Professional | 26 | $102.33 | $199.53 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $562.34 / $1,348.96
| Professional | TC | $263.03 | $562.34 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,071.52 / $1,479.11
| Professional | | $489.78 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $302.00
| Professional | 26 | $104.71 | $154.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $831.76 / $1,318.26
| Professional | TC | $338.84 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,000.00 / $1,513.56
| Professional | | $478.63 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $165.96
| Professional | 26 | $114.82 | $138.04 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $851.14
| Professional | TC | $323.59 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $1,000.00
| Professional | | $151.36 | $190.55 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $524.81 / $1,778.28
| Professional | | $338.84 | $524.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $416.87
| Professional | 26 | $93.33 | $131.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $1,348.96
| Professional | TC | $245.47 | $363.08 | $1,348.96 |