- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $257.04
| Facility | 26 | $54.95 | $107.15 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $251.19 / $616.60
| Professional | | $138.04 | $251.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $186.21
| Professional | 26 | $53.70 | $83.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $144.54 / $316.23
| Professional | TC | $79.43 | $144.54 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $112.20 / $123.03
| Professional | | $93.33 | $112.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $102.33
| Professional | 26 | $45.71 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $269.15 / $457.09
| Professional | | $158.49 | $269.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $120.23
| Professional | 26 | $57.54 | $77.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $173.78 / $338.84
| Professional | TC | $93.33 | $173.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $169.82
| Professional | | $57.54 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $288.40 / $524.81
| Professional | | $131.83 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $154.88
| Professional | 26 | $50.12 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $181.97 / $363.08
| Professional | TC | $77.62 | $181.97 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $181.97 / $741.31
| Professional | | $138.04 | $181.97 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $239.88
| Professional | 26 | $54.95 | $75.86 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $741.31
| Professional | TC | $83.18 | $107.15 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $123.03 / $269.15
| Professional | | $57.54 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $426.58
| Professional | | $134.90 | $234.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $70.79 / $134.90
| Professional | 26 | $51.29 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $141.25 / $302.00
| Professional | TC | $79.43 | $141.25 | $302.00 |