- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $109.65
| Facility | 26 | $91.20 | $91.20 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $1,380.38
| Professional | | $218.78 | $338.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $223.87
| Professional | 26 | $64.57 | $85.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $371.54
| Professional | TC | $151.36 | $213.80 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $58.88
| Professional | 26 | $56.23 | $56.23 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | TC | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $239.88 / $380.19
| Professional | | $218.78 | $239.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $123.03
| Professional | 26 | $64.57 | $72.44 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $158.49 / $269.15
| Professional | TC | $147.91 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $549.54
| Professional | | $223.87 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $134.90
| Professional | 26 | $57.54 | $91.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $426.58
| Professional | TC | $151.36 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $288.40 / $371.54
| Professional | | $2.95 | $288.40 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.78 / $87.10 / $117.49
| Professional | 26 | $0.78 | $87.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $190.55 / $257.04
| Professional | TC | $10.96 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $2.95 / $331.13
| Professional | | $2.95 | $2.95 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.78 / $0.78 / $109.65
| Professional | 26 | $0.78 | $0.78 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.19 / $151.36 / $218.78
| Professional | TC | $2.19 | $151.36 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $218.78 / $234.42
| Professional | | $208.93 | $218.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $77.62
| Professional | 26 | $72.44 | $74.13 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $144.54 / $154.88
| Professional | TC | $138.04 | $144.54 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $489.78
| Professional | | $190.55 | $295.12 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $134.90
| Professional | 26 | $52.48 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $204.17 / $398.11
| Professional | TC | $141.25 | $204.17 | $398.11 |