- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $173.78 / $173.78
| Facility | 26 | $77.62 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $549.54 / $1,584.89
| Professional | | $281.84 | $549.54 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $87.10 / $281.84
| Professional | 26 | $77.62 | $87.10 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $229.09 / $1,288.25
| Professional | TC | $204.17 | $229.09 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | 26 | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $616.60
| Professional | | $269.15 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $125.89 / $169.82
| Professional | 26 | $75.86 | $125.89 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $436.52
| Professional | TC | $194.98 | $316.23 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $660.69 / $831.76
| Professional | | $281.84 | $660.69 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $190.55 / $257.04
| Professional | 26 | $91.20 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $478.63 / $588.84
| Professional | TC | $199.53 | $478.63 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 26 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $588.84 / $2,238.72
| Professional | | $371.54 | $588.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $177.83 / $691.83
| Professional | 26 | $114.82 | $177.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $1,584.89
| Professional | TC | $263.03 | $407.38 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $630.96 / $933.25
| Professional | | $602.56 | $630.96 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $204.17 / $263.03
| Professional | 26 | $181.97 | $204.17 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $436.52 / $660.69
| Professional | TC | $426.58 | $436.52 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | 26 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | TC | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $501.19 / $831.76
| Professional | | $3.02 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $724.44
| Professional | | $371.54 | $549.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $162.18 / $213.80
| Professional | 26 | $112.20 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $512.86
| Professional | TC | $257.04 | $371.54 | $512.86 |