- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $50.12 / $208.93
| Facility | 26 | $30.20 | $50.12 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $190.55
| Professional | | $89.13 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $81.28
| Professional | 26 | $30.20 | $38.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $125.89
| Professional | TC | $63.10 | $85.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $47.86
| Professional | 26 | $28.84 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $117.49 / $158.49
| Professional | | $38.02 | $117.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $51.29
| Facility | 26 | $31.62 | $31.62 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $107.15 / $169.82
| Professional | | $83.18 | $107.15 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $37.15 / $60.26
| Professional | 26 | $27.54 | $37.15 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $114.82
| Professional | TC | $56.23 | $70.79 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $173.78
| Facility | 26 | $89.13 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $812.83
| Professional | | $97.72 | $123.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $239.88
| Professional | 26 | $33.11 | $40.74 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $79.43 / $575.44
| Professional | TC | $64.57 | $79.43 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $186.21
| Professional | | $95.50 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $66.07
| Professional | 26 | $33.11 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $114.82
| Professional | TC | $64.57 | $75.86 | $114.82 |