- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $141.25
| Facility | 26 | $128.82 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $251.19 / $426.58
| Professional | | $204.17 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $295.12
| Professional | 26 | $120.23 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $141.25
| Professional | TC | $75.86 | $89.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $169.82 / $389.05
| Professional | | $70.79 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $147.91 / $208.93
| Facility | 26 | $31.62 | $147.91 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $977.24
| Professional | | $194.98 | $331.13 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $602.56
| Professional | 26 | $123.03 | $194.98 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $371.54
| Professional | TC | $75.86 | $131.83 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $436.52
| Professional | | $190.55 | $269.15 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $263.03 / $269.15
| Professional | 26 | $165.96 | $263.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $263.03 / $363.08
| Professional | | $181.97 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $213.80
| Professional | 26 | $104.71 | $151.36 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $154.88
| Professional | TC | $74.13 | $109.65 | $154.88 |