- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $234.42
| Facility | 26 | $31.62 | $48.98 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $741.31
| Professional | | $234.42 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $89.13
| Professional | 26 | $30.90 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $645.65
| Professional | TC | $199.53 | $275.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $60.26
| Professional | 26 | $27.54 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $114.82
| Professional | 26 | $43.65 | $61.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $630.96
| Professional | | $208.93 | $346.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $45.71 / $79.43
| Professional | 26 | $27.54 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $549.54
| Professional | TC | $169.82 | $302.00 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | 26 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | TC | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $354.81 / $562.34
| Professional | | $302.00 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $64.57
| Professional | 26 | $31.62 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $501.19
| Professional | TC | $269.15 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $354.81 / $676.08
| Professional | | $218.78 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $77.62
| Professional | 26 | $30.20 | $44.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $316.23 / $616.60
| Professional | TC | $213.80 | $316.23 | $616.60 |