- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $478.63 / $676.08
| Facility | 26 | $158.49 | $478.63 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $812.83
| Professional | | $125.89 | $234.42 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $169.82 / $371.54
| Professional | 26 | $95.50 | $169.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $63.10 / $173.78
| Professional | TC | $25.12 | $63.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $257.04 / $363.08
| Professional | | $131.83 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $263.03
| Professional | 26 | $97.72 | $169.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $95.50 / $134.90
| Professional | TC | $31.62 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $323.59 / $741.31
| Professional | | $177.83 | $323.59 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $263.03
| Professional | 26 | $123.03 | $158.49 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $79.43 / $602.56
| Professional | TC | $42.66 | $79.43 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $676.08
| Professional | | $169.82 | $239.88 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $144.54
| Professional | 26 | $97.72 | $117.49 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $120.23
| Professional | TC | $44.67 | $56.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $194.98 / $263.03
| Professional | | $190.55 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $199.53 / $676.08
| Professional | | $134.90 | $199.53 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $141.25 / $251.19
| Professional | 26 | $93.33 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $46.77 / $363.08
| Professional | TC | $26.30 | $46.77 | $363.08 |