- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $177.83 / $398.11
| Facility | 26 | $85.11 | $177.83 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $1,071.52
| Professional | | $346.74 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $263.03
| Professional | 26 | $83.18 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $691.83
| Professional | TC | $257.04 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $933.25
| Professional | | $389.05 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $177.83
| Professional | 26 | $74.13 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $758.58
| Professional | TC | $281.84 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $645.65 / $1,096.48
| Professional | | $331.13 | $645.65 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $229.09
| Professional | 26 | $75.86 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $489.78 / $891.25
| Professional | TC | $257.04 | $489.78 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $1,445.44
| Professional | | $338.84 | $446.68 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $302.00
| Professional | 26 | $83.18 | $107.15 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $1,380.38
| Professional | TC | $257.04 | $338.84 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $316.23 / $616.60
| Professional | | $87.10 | $316.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $933.25
| Professional | | $354.81 | $537.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $190.55
| Professional | 26 | $77.62 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $416.87 / $724.44
| Professional | TC | $263.03 | $416.87 | $724.44 |