- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $131.83
| Facility | 26 | $109.65 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $1,949.84
| Professional | | $323.59 | $478.63 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $147.91 / $602.56
| Professional | 26 | $97.72 | $147.91 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $501.19
| Professional | TC | $218.78 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $512.86
| Professional | | $229.09 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $229.09
| Professional | 26 | $81.28 | $85.11 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $380.19 / $602.56
| Professional | | $346.74 | $380.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $112.20 / $177.83
| Professional | 26 | $102.33 | $112.20 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $269.15 / $426.58
| Professional | TC | $239.88 | $269.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $660.69
| Professional | | $323.59 | $457.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $190.55
| Professional | 26 | $91.20 | $131.83 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $457.09
| Professional | TC | $229.09 | $316.23 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $407.38 / $537.03
| Professional | | $3.16 | $407.38 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.17 / $125.89 / $169.82
| Professional | 26 | $1.17 | $125.89 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $281.84 / $371.54
| Professional | TC | $2.00 | $281.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.16 / $3.16 / $512.86
| Professional | | $3.16 | $3.16 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.17 / $1.17 / $158.49
| Professional | 26 | $1.17 | $1.17 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $354.81
| Professional | TC | $2.00 | $2.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $338.84 / $363.08
| Professional | | $323.59 | $338.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $109.65
| Professional | 26 | $104.71 | $104.71 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $234.42 / $257.04
| Professional | TC | $218.78 | $234.42 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $1,122.02
| Professional | | $295.12 | $489.78 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $100.00 / $190.55
| Professional | 26 | $61.66 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $1,148.15
| Professional | TC | $234.42 | $416.87 | $1,148.15 |