- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $67.61 / $87.10
| Facility | 26 | $61.66 | $67.61 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $213.80 / $426.58
| Professional | | $173.78 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $123.03
| Professional | 26 | $41.69 | $52.48 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $234.42
| Professional | TC | $128.82 | $162.18 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $302.00 / $363.08
| Professional | | $251.19 | $302.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $72.44 / $89.13
| Professional | 26 | $57.54 | $72.44 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $275.42
| Professional | TC | $186.21 | $234.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $50.12 / $50.12
| Professional | 26 | $48.98 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $229.09 / $501.19
| Professional | | $141.25 | $229.09 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $107.15
| Professional | 26 | $37.15 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $331.13
| Professional | TC | $104.71 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $234.42 / $363.08
| Professional | | $173.78 | $234.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $57.54 / $85.11
| Professional | 26 | $43.65 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $263.03
| Professional | TC | $128.82 | $173.78 | $263.03 |