- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $144.54
| Facility | 26 | $87.10 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $741.31
| Professional | | $295.12 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $158.49
| Professional | 26 | $79.43 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $407.38
| Professional | TC | $199.53 | $245.47 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $549.54
| Professional | | $288.40 | $380.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $151.36
| Professional | 26 | $79.43 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $398.11
| Professional | TC | $208.93 | $275.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $371.54 / $2,511.89
| Professional | | $109.65 | $371.54 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $141.25
| Professional | 26 | $83.18 | $104.71 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $331.13
| Professional | TC | $213.80 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $398.11 / $660.69
| Professional | | $257.04 | $398.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $177.83
| Professional | 26 | $81.28 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $288.40 / $489.78
| Professional | TC | $181.97 | $288.40 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $316.23 / $851.14
| Professional | | $263.03 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $97.72 / $251.19
| Professional | 26 | $83.18 | $97.72 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $602.56
| Professional | TC | $181.97 | $218.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $537.03 / $741.31
| Professional | | $426.58 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $194.98
| Professional | 26 | $123.03 | $154.88 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $338.84 / $1,698.24
| Professional | | $104.71 | $338.84 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $186.21
| Professional | 26 | $87.10 | $114.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $489.78
| Professional | TC | $208.93 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $630.96
| Professional | | $251.19 | $407.38 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $177.83
| Professional | 26 | $72.44 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $467.74
| Professional | TC | $177.83 | $288.40 | $467.74 |