- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $47.86
| Facility | 26 | $29.51 | $37.15 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $208.93
| Professional | | $75.86 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $85.11
| Professional | 26 | $22.91 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $123.03
| Professional | TC | $53.70 | $72.44 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $131.83 / $199.53
| Professional | | $89.13 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $56.23
| Professional | 26 | $25.12 | $37.15 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $144.54
| Professional | TC | $61.66 | $95.50 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Facility | 26 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $208.93
| Professional | | $75.86 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $60.26
| Professional | 26 | $20.89 | $31.62 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $144.54
| Professional | TC | $54.95 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $154.88 / $501.19
| Professional | | $134.90 | $154.88 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $43.65 / $151.36
| Professional | 26 | $39.81 | $43.65 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $346.74
| Professional | TC | $100.00 | $109.65 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $97.72 / $147.91
| Professional | | $95.50 | $97.72 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $28.18 / $44.67
| Professional | 26 | $27.54 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $70.79 / $102.33
| Professional | TC | $66.07 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $134.90 / $208.93
| Professional | | $83.18 | $134.90 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $47.86 / $83.18
| Professional | 26 | $22.91 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $138.04
| Professional | TC | $60.26 | $91.20 | $138.04 |