- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $275.42 / $512.86
| Facility | 26 | $95.50 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $1,318.26
| Professional | | $309.03 | $457.09 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $165.96 / $457.09
| Professional | 26 | $93.33 | $165.96 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $537.03
| Professional | TC | $199.53 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $416.87 / $457.09
| Professional | | $229.09 | $416.87 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $199.53
| Professional | 26 | $89.13 | $141.25 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $489.78 / $741.31
| Professional | | $380.19 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $223.87
| Professional | 26 | $112.20 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $524.81
| Professional | TC | $257.04 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $251.19 / $426.58
| Professional | | $112.20 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $549.54 / $1,000.00
| Professional | | $331.13 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $295.12
| Professional | 26 | $95.50 | $154.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $380.19 / $707.95
| Professional | TC | $229.09 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $2,290.87
| Professional | | $346.74 | $446.68 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $281.84
| Professional | 26 | $107.15 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $295.12 / $616.60
| Professional | TC | $239.88 | $295.12 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $316.23 / $588.84
| Professional | | $112.20 | $316.23 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $691.83 / $1,412.54
| Professional | | $363.08 | $691.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $251.19
| Professional | 26 | $79.43 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $1,148.15
| Professional | TC | $251.19 | $501.19 | $1,148.15 |