- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $141.25 / $141.25
| Facility | 26 | $107.15 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $323.59
| Professional | | $74.13 | $117.49 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $114.82
| Professional | 26 | $25.70 | $38.90 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $218.78
| Professional | TC | $52.48 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $338.84
| Professional | | $123.03 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $54.95 / $114.82
| Professional | 26 | $38.90 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $223.87
| Professional | TC | $83.18 | $117.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $141.25
| Facility | 26 | $107.15 | $107.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $691.83
| Professional | | $117.49 | $281.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $95.50 / $239.88
| Professional | 26 | $37.15 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $194.98 / $446.68
| Professional | TC | $81.28 | $194.98 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $446.68 / $676.08
| Professional | | $398.11 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $131.83 / $218.78
| Professional | 26 | $120.23 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $309.03 / $467.74
| Professional | TC | $257.04 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $275.42 / $338.84
| Professional | | $128.82 | $275.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $123.03
| Professional | 26 | $28.18 | $46.77 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $97.72 / $223.87
| Professional | TC | $69.18 | $97.72 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $263.03 / $524.81
| Professional | | $128.82 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $97.72 / $194.98
| Professional | 26 | $39.81 | $97.72 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $331.13
| Professional | TC | $89.13 | $165.96 | $331.13 |