- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $89.13
| Facility | 26 | $52.48 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $199.53 / $645.65
| Professional | | $131.83 | $199.53 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $162.18
| Professional | 26 | $48.98 | $70.79 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $275.42
| Professional | TC | $81.28 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $42.66
| Facility | 26 | $35.48 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $489.78
| Professional | | $223.87 | $338.84 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $128.82 / $181.97
| Professional | 26 | $83.18 | $128.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $229.09 / $302.00
| Professional | TC | $141.25 | $229.09 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $186.21 / $446.68
| Facility | 26 | $83.18 | $186.21 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $537.03
| Professional | | $208.93 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $162.18
| Professional | 26 | $58.88 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $165.96 / $354.81
| Professional | TC | $131.83 | $165.96 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $354.81
| Facility | 26 | $147.91 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $478.63
| Professional | | $208.93 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $138.04
| Professional | 26 | $75.86 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $323.59
| Professional | TC | $131.83 | $131.83 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | 26 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $1,584.89
| Professional | | $154.88 | $309.03 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $323.59
| Professional | 26 | $54.95 | $109.65 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $181.97 / $1,318.26
| Professional | TC | $91.20 | $181.97 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $223.87 / $1,122.02
| Professional | | $85.11 | $223.87 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $426.58
| Professional | 26 | $66.07 | $104.71 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $302.00
| Professional | TC | $89.13 | $173.78 | $302.00 |