- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $128.82 / $128.82
| Facility | 26 | $117.49 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $660.69
| Professional | | $269.15 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $251.19
| Professional | 26 | $83.18 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $338.84
| Professional | TC | $162.18 | $218.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $302.00 / $691.83
| Professional | | $147.91 | $302.00 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $128.82 / $186.21
| Facility | 26 | $27.54 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $630.96 / $1,548.82
| Professional | | $257.04 | $630.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $524.81
| Professional | 26 | $91.20 | $162.18 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $467.74 / $1,000.00
| Professional | TC | $173.78 | $467.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $194.98 / $302.00
| Professional | 26 | $186.21 | $194.98 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $398.11
| Professional | TC | $354.81 | $354.81 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $602.56 / $1,071.52
| Professional | | $257.04 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $128.82 / $229.09
| Professional | 26 | $67.61 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $416.87 / $870.96
| Professional | TC | $181.97 | $416.87 | $870.96 |