- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $91.20 / $123.03
| Facility | 26 | $37.15 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $131.83 / $363.08
| Professional | | $89.13 | $131.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $93.33
| Professional | 26 | $21.88 | $35.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $208.93
| Professional | TC | $67.61 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $38.90
| Professional | 26 | $18.62 | $23.44 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $512.86
| Professional | | $107.15 | $125.89 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $39.81
| Professional | 26 | $19.95 | $25.12 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $416.87
| Professional | TC | $87.10 | $102.33 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $28.84 / $40.74
| Facility | 26 | $6.17 | $28.84 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $263.03
| Professional | | $85.11 | $128.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $54.95
| Professional | 26 | $21.38 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $213.80
| Professional | TC | $60.26 | $97.72 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $114.82 / $114.82
| Facility | 26 | $58.88 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $851.14
| Professional | | $87.10 | $131.83 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $204.17
| Professional | 26 | $24.55 | $28.84 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $104.71 / $676.08
| Professional | TC | $61.66 | $104.71 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $257.04
| Professional | | $85.11 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $79.43
| Professional | 26 | $23.99 | $27.54 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $154.88
| Professional | TC | $60.26 | $102.33 | $154.88 |