- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $169.82
| Facility | 26 | $75.86 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $1,698.24
| Professional | | $218.78 | $331.13 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $323.59
| Professional | 26 | $74.13 | $91.20 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $630.96
| Professional | TC | $162.18 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Facility | 26 | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $676.08 / $912.01
| Professional | | $389.05 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $190.55 / $239.88
| Professional | 26 | $85.11 | $190.55 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $478.63 / $676.08
| Professional | TC | $281.84 | $478.63 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $489.78 / $1,479.11
| Professional | | $251.19 | $489.78 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $151.36 / $436.52
| Professional | 26 | $77.62 | $151.36 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $380.19 / $1,174.90
| Professional | TC | $177.83 | $380.19 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $776.25
| Facility | 26 | $602.56 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $588.84 / $3,235.94
| Professional | | $302.00 | $588.84 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $870.96
| Professional | 26 | $85.11 | $141.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $426.58 / $2,754.23
| Professional | TC | $199.53 | $426.58 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $758.58 / $954.99
| Professional | | $512.86 | $758.58 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $257.04
| Professional | 26 | $165.96 | $204.17 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $758.58
| Professional | TC | $346.74 | $501.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Facility | 26 | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,023.29
| Professional | | $630.96 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $223.87
| Professional | 26 | $154.88 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $870.96
| Professional | TC | $426.58 | $549.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $199.53 / $467.74
| Professional | | $83.18 | $199.53 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $489.78 / $1,445.44
| Professional | | $288.40 | $489.78 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $288.40
| Professional | 26 | $85.11 | $125.89 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $338.84 / $741.31
| Professional | TC | $199.53 | $338.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $630.96
| Professional | | $537.03 | $537.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $186.21
| Professional | 26 | $158.49 | $158.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $446.68
| Professional | TC | $380.19 | $380.19 | $446.68 |