- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $107.15 / $275.42
| Facility | 26 | $34.67 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $457.09
| Professional | | $123.03 | $151.36 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $87.10 / $288.40
| Professional | 26 | $33.11 | $87.10 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $457.09
| Professional | TC | $89.13 | $125.89 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $158.49 / $316.23
| Professional | | $35.48 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $39.81
| Professional | 26 | $21.88 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $123.03 / $123.03
| Professional | TC | $54.95 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $741.31
| Professional | | $75.86 | $104.71 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $33.11 / $162.18
| Professional | 26 | $18.62 | $33.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $588.84
| Professional | TC | $38.90 | $74.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $371.54 / $416.87
| Professional | | $223.87 | $371.54 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $87.10 / $91.20
| Professional | 26 | $50.12 | $87.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $331.13
| Professional | TC | $173.78 | $281.84 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $407.38
| Professional | | $109.65 | $141.25 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $169.82
| Professional | 26 | $28.84 | $43.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $109.65 / $323.59
| Professional | TC | $75.86 | $109.65 | $323.59 |