- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $70.79 / $89.13
| Facility | 26 | $63.10 | $70.79 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $758.58
| Professional | | $239.88 | $316.23 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $61.66 / $275.42
| Professional | 26 | $38.02 | $61.66 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $630.96
| Professional | TC | $204.17 | $269.15 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $204.17 / $354.81
| Professional | | $46.77 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $478.63 / $660.69
| Professional | | $354.81 | $478.63 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $117.49
| Professional | 26 | $56.23 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $549.54
| Professional | TC | $295.12 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $239.88
| Professional | | $32.36 | $33.11 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $478.63 / $660.69
| Professional | | $354.81 | $478.63 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $117.49
| Professional | 26 | $56.23 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $549.54
| Professional | TC | $295.12 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $302.00 / $676.08
| Professional | | $288.40 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $46.77 / $104.71
| Professional | 26 | $44.67 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $257.04 / $562.34
| Professional | TC | $245.47 | $257.04 | $562.34 |