- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | 26 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $263.03 / $645.65
| Professional | | $169.82 | $263.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $120.23 / $323.59
| Professional | 26 | $54.95 | $120.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $281.84
| Professional | TC | $100.00 | $131.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $645.65 / $1,513.56
| Professional | | $457.09 | $645.65 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $169.82 / $398.11
| Professional | 26 | $95.50 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $467.74 / $1,122.02
| Professional | TC | $323.59 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | 26 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,096.48 / $2,630.27
| Professional | | $338.84 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $331.13 / $831.76
| Professional | 26 | $138.04 | $331.13 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $794.33 / $1,819.70
| Professional | TC | $208.93 | $794.33 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,778.28 / $3,019.95
| Professional | | $1,737.80 | $1,778.28 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $457.09 / $758.58
| Professional | 26 | $416.87 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,318.26 / $2,187.76
| Professional | TC | $1,122.02 | $1,318.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,071.52 / $1,348.96
| Professional | | $478.63 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $389.05
| Professional | 26 | $95.50 | $162.18 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,071.52
| Professional | TC | $323.59 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,148.15 / $2,754.23
| Professional | | $295.12 | $1,148.15 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $338.84 / $812.83
| Professional | 26 | $125.89 | $338.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $812.83 / $1,949.84
| Professional | TC | $147.91 | $812.83 | $1,949.84 |