- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $141.25
| Facility | 26 | $85.11 | $109.65 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $1,288.25
| Professional | | $407.38 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $234.42
| Professional | 26 | $72.44 | $97.72 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $426.58 / $891.25
| Professional | TC | $346.74 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $933.25
| Professional | | $416.87 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $162.18
| Professional | 26 | $77.62 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $758.58
| Professional | TC | $338.84 | $501.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $691.83 / $1,096.48
| Professional | | $426.58 | $691.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $173.78
| Professional | 26 | $77.62 | $120.23 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $575.44 / $933.25
| Professional | TC | $354.81 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $724.44 / $1,202.26
| Professional | | $660.69 | $724.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $131.83 / $288.40
| Professional | 26 | $120.23 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $602.56 / $912.01
| Professional | TC | $537.03 | $602.56 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $467.74 / $478.63
| Professional | | $407.38 | $467.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $83.18 / $85.11
| Professional | 26 | $81.28 | $83.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $380.19 / $398.11
| Professional | TC | $331.13 | $380.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $707.95 / $1,174.90
| Professional | | $512.86 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $218.78
| Professional | 26 | $93.33 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $954.99
| Professional | TC | $380.19 | $562.34 | $954.99 |