- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $229.09
| Facility | 26 | $123.03 | $194.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $407.38
| Professional | | $134.90 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $208.93
| Professional | 26 | $57.54 | $89.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $107.15 / $234.42
| Professional | TC | $57.54 | $107.15 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $104.71 / $151.36
| Facility | 26 | $22.39 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $354.81 / $562.34
| Professional | | $223.87 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $154.88 / $257.04
| Professional | 26 | $72.44 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $181.97 / $426.58
| Professional | TC | $104.71 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $354.81 / $426.58
| Professional | | $316.23 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $194.98 / $229.09
| Professional | 26 | $169.82 | $194.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $162.18 / $199.53
| Professional | TC | $144.54 | $162.18 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $229.09
| Facility | 26 | $123.03 | $194.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $354.81 / $616.60
| Professional | | $251.19 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $181.97 / $269.15
| Professional | 26 | $83.18 | $181.97 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $380.19
| Professional | TC | $114.82 | $165.96 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $281.84
| Professional | | $100.00 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $371.54 / $512.86
| Professional | | $281.84 | $371.54 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $257.04
| Professional | 26 | $100.00 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $407.38
| Professional | TC | $117.49 | $199.53 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | 26 | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $478.63
| Professional | | $309.03 | $389.05 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $257.04
| Professional | 26 | $125.89 | $194.98 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $234.42
| Professional | TC | $134.90 | $177.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $309.03 / $537.03
| Professional | | $177.83 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $251.19
| Professional | 26 | $66.07 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $147.91 / $323.59
| Professional | TC | $81.28 | $147.91 | $323.59 |