- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $239.88 / $467.74
| Facility | 26 | $97.72 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $1,698.24
| Professional | | $275.42 | $436.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $204.17
| Professional | 26 | $70.79 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $302.00 / $575.44
| Professional | TC | $199.53 | $302.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $478.63
| Professional | | $371.54 | $371.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $269.15 / $588.84
| Professional | | $257.04 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $72.44 / $141.25
| Professional | 26 | $69.18 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $194.98 / $489.78
| Professional | TC | $186.21 | $194.98 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $812.83
| Professional | | $269.15 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $141.25
| Professional | 26 | $53.70 | $87.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $645.65
| Professional | TC | $199.53 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $436.52
| Professional | | $269.15 | $363.08 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $91.20 / $109.65
| Professional | 26 | $67.61 | $91.20 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $331.13
| Professional | TC | $199.53 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $645.65
| Professional | | $269.15 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $144.54
| Professional | 26 | $60.26 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $512.86
| Professional | TC | $194.98 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $549.54
| Professional | | $309.03 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $120.23
| Professional | 26 | $77.62 | $91.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | TC | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $371.54 / $478.63
| Professional | | $302.00 | $371.54 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $416.87
| Facility | 26 | $97.72 | $125.89 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $457.09 / $912.01
| Professional | | $275.42 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $120.23 / $208.93
| Professional | 26 | $70.79 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $323.59 / $645.65
| Professional | TC | $204.17 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $707.95 / $831.76
| Professional | | $467.74 | $707.95 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $77.62 / $77.62
| Facility | 26 | $69.18 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $302.00 / $501.19
| Professional | | $128.82 | $302.00 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $69.18 / $77.62
| Professional | 26 | $67.61 | $69.18 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $194.98 / $426.58
| Professional | TC | $190.55 | $194.98 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $389.05 / $691.83
| Professional | | $251.19 | $389.05 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $81.28 / $147.91
| Professional | 26 | $60.26 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $549.54
| Professional | TC | $190.55 | $288.40 | $549.54 |