- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $190.55
| Facility | 26 | $43.65 | $70.79 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $512.86
| Professional | | $208.93 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $128.82
| Professional | 26 | $41.69 | $53.70 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $426.58
| Professional | TC | $162.18 | $229.09 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | 26 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $537.03
| Professional | | $194.98 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $56.23 / $100.00
| Professional | 26 | $38.02 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $223.87 / $436.52
| Professional | TC | $151.36 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $58.88 / $162.18
| Facility | 26 | $10.96 | $58.88 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $389.05 / $758.58
| Professional | | $251.19 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $125.89
| Professional | 26 | $44.67 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $323.59 / $645.65
| Professional | TC | $204.17 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $630.96
| Professional | | $239.88 | $346.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $128.82
| Professional | 26 | $41.69 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $537.03
| Professional | TC | $199.53 | $288.40 | $537.03 |