- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $89.13 / $257.04
| Facility | 26 | $64.57 | $89.13 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $478.63 / $1,737.80
| Professional | | $144.54 | $478.63 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $134.90 / $309.03
| Professional | 26 | $64.57 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $776.25
| Professional | TC | $223.87 | $354.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $263.03 / $407.38
| Facility | 26 | $151.36 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $3,019.95
| Professional | | $354.81 | $537.03 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $467.74
| Professional | 26 | $56.23 | $89.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $2,570.40
| Professional | TC | $295.12 | $467.74 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,071.52 / $1,445.44
| Professional | | $630.96 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $125.89 / $165.96
| Professional | 26 | $72.44 | $125.89 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $588.84 / $1,047.13
| Professional | | $288.40 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $93.33 / $190.55
| Professional | 26 | $53.70 | $93.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $501.19 / $851.14
| Professional | TC | $239.88 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $338.84 / $602.56
| Professional | | $79.43 | $338.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $851.14
| Professional | | $331.13 | $512.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $169.82
| Professional | 26 | $64.57 | $97.72 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $676.08
| Professional | TC | $263.03 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $131.83
| Professional | | $91.20 | $120.23 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $263.03 / $407.38
| Facility | 26 | $151.36 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $3,019.95
| Professional | | $354.81 | $537.03 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $467.74
| Professional | 26 | $56.23 | $89.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $2,570.40
| Professional | TC | $295.12 | $467.74 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $1,000.00
| Professional | | $346.74 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $208.93
| Professional | 26 | $61.66 | $93.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $426.58 / $794.33
| Professional | TC | $288.40 | $426.58 | $794.33 |