- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $144.54
| Facility | 26 | $114.82 | $114.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $123.03 / $223.87
| Professional | | $97.72 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $81.28 / $120.23
| Professional | 26 | $47.86 | $81.28 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $58.88 / $93.33
| Professional | TC | $44.67 | $58.88 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 26 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $218.78
| Professional | | $151.36 | $177.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $102.33
| Professional | 26 | $81.28 | $95.50 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $91.20
| Professional | TC | $69.18 | $81.28 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $141.25 / $213.80
| Professional | | $112.20 | $141.25 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $97.72
| Professional | 26 | $58.88 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $104.71
| Professional | TC | $53.70 | $67.61 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $144.54
| Facility | 26 | $114.82 | $114.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $251.19
| Professional | | $100.00 | $165.96 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $114.82
| Professional | 26 | $61.66 | $87.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $125.89
| Professional | TC | $58.88 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 26 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $186.21 / $194.98
| Professional | | $165.96 | $186.21 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $102.33
| Professional | 26 | $87.10 | $100.00 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $91.20
| Professional | TC | $77.62 | $89.13 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $660.69
| Professional | | $89.13 | $89.13 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $104.71
| Professional | 26 | $47.86 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $41.69 / $870.96
| Professional | TC | $40.74 | $41.69 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $208.93
| Professional | | $104.71 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $61.66 / $100.00
| Professional | 26 | $47.86 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $112.20
| Professional | TC | $48.98 | $64.57 | $112.20 |