- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $288.40
| Facility | 26 | $60.26 | $95.50 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $117.49 / $269.15
| Professional | | $89.13 | $117.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $1,513.56
| Professional | 25 | $218.78 | $218.78 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $165.96
| Professional | 26 | $54.95 | $70.79 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $87.10
| Professional | TC | $30.20 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $123.03 / $239.88
| Professional | | $77.62 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $154.88
| Professional | 26 | $56.23 | $81.28 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $41.69 / $91.20
| Professional | TC | $20.89 | $41.69 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $77.62 / $213.80
| Facility | 26 | $14.45 | $77.62 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $331.13
| Professional | | $100.00 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $194.98
| Professional | 26 | $61.66 | $93.33 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $141.25
| Professional | TC | $32.36 | $52.48 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $257.04
| Professional | | $83.18 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $158.49
| Professional | 26 | $54.95 | $79.43 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $100.00
| Professional | TC | $27.54 | $43.65 | $100.00 |