- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $74.13
| Facility | 26 | $30.90 | $39.81 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $269.15
| Professional | | $95.50 | $144.54 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $91.20
| Professional | 26 | $28.18 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $35.48 / $77.62 / $134.90
| Professional | 52 | $35.48 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $95.50 / $194.98
| Professional | TC | $70.79 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $194.98
| Professional | | $70.79 | $89.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $38.90
| Professional | 26 | $24.55 | $25.70 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $97.72
| Professional | TC | $52.48 | $70.79 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $223.87
| Professional | | $91.20 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $66.07
| Professional | 26 | $28.18 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $169.82
| Professional | TC | $66.07 | $89.13 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $147.91
| Facility | 26 | $77.62 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $776.25
| Professional | | $112.20 | $151.36 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $288.40
| Professional | 26 | $33.88 | $44.67 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $575.44
| Professional | TC | $77.62 | $104.71 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $213.80
| Professional | | $109.65 | $131.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $64.57
| Professional | 26 | $33.11 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $93.33 / $158.49
| Professional | TC | $77.62 | $93.33 | $158.49 |