- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $407.38
| Facility | 26 | $102.33 | $169.82 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $2,238.72
| Professional | | $234.42 | $512.86 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $478.63
| Professional | 26 | $102.33 | $190.55 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $416.87 / $1,047.13
| Professional | TC | $281.84 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $645.65 / $645.65
| Facility | 26 | $239.88 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $870.96 / $6,165.95
| Professional | | $489.78 | $870.96 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $141.25 / $676.08
| Professional | 26 | $91.20 | $141.25 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $758.58 / $5,623.41
| Professional | TC | $380.19 | $758.58 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,479.11 / $2,238.72
| Professional | | $870.96 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $263.03
| Professional | 26 | $117.49 | $199.53 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $812.83 / $1,445.44
| Professional | | $371.54 | $812.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $302.00
| Professional | 26 | $83.18 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $660.69 / $1,174.90
| Professional | TC | $316.23 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $436.52 / $812.83
| Professional | | $125.89 | $436.52 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $691.83 / $1,202.26
| Professional | | $446.68 | $691.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $263.03
| Professional | 26 | $102.33 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $870.96
| Professional | TC | $338.84 | $501.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $165.96 / $223.87
| Professional | | $144.54 | $165.96 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $645.65 / $645.65
| Facility | 26 | $239.88 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $870.96 / $6,165.95
| Professional | | $489.78 | $870.96 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $141.25 / $676.08
| Professional | 26 | $91.20 | $141.25 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $758.58 / $5,623.41
| Professional | TC | $380.19 | $758.58 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $776.25 / $1,548.82
| Professional | | $467.74 | $776.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $331.13
| Professional | 26 | $97.72 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $602.56 / $1,230.27
| Professional | TC | $371.54 | $602.56 | $1,230.27 |