- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $70.79
| Facility | 26 | $38.90 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $125.89 / $269.15
| Professional | | $91.20 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $56.23
| Professional | 26 | $20.89 | $26.92 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $208.93
| Professional | TC | $72.44 | $100.00 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $234.42 / $331.13
| Professional | | $199.53 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $67.61
| Professional | 26 | $42.66 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $186.21 / $257.04
| Professional | TC | $158.49 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $257.04
| Professional | | $104.71 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $57.54
| Professional | 26 | $26.92 | $41.69 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $190.55
| Professional | TC | $83.18 | $144.54 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $512.86
| Professional | | $323.59 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $120.23 / $120.23
| Professional | 26 | $112.20 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $398.11
| Professional | TC | $208.93 | $208.93 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $58.88 / $70.79
| Facility | 26 | $38.90 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $331.13
| Professional | | $128.82 | $257.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $70.79
| Professional | 26 | $27.54 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $204.17 / $263.03
| Professional | TC | $97.72 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $85.11
| Professional | | $21.38 | $33.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $316.23
| Professional | | $190.55 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $64.57
| Professional | 26 | $43.65 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $251.19
| Professional | TC | $151.36 | $218.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $128.82 / $275.42
| Professional | | $125.89 | $128.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $57.54
| Professional | 26 | $25.70 | $25.70 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $218.78
| Professional | TC | $100.00 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $223.87
| Professional | | $104.71 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $53.70
| Professional | 26 | $27.54 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $165.96
| Professional | TC | $75.86 | $93.33 | $165.96 |