- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $91.20
| Facility | 26 | $38.90 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $1,023.29
| Professional | | $223.87 | $309.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $138.04
| Professional | 26 | $35.48 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $245.47 / $707.95
| Professional | TC | $186.21 | $245.47 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $57.54
| Professional | 26 | $43.65 | $56.23 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $309.03 / $478.63
| Professional | | $275.42 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $85.11
| Professional | 26 | $41.69 | $52.48 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $257.04 / $407.38
| Professional | TC | $223.87 | $257.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $281.84 / $426.58
| Professional | | $269.15 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $46.77 / $66.07
| Professional | 26 | $42.66 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $257.04 / $354.81
| Professional | TC | $229.09 | $257.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $524.81
| Professional | | $213.80 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $87.10
| Professional | 26 | $36.31 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $446.68
| Professional | TC | $173.78 | $288.40 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $223.87 / $223.87
| Facility | 26 | $95.50 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $1,819.70
| Professional | | $234.42 | $346.74 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $331.13
| Professional | 26 | $37.15 | $56.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $295.12 / $1,548.82
| Professional | TC | $194.98 | $295.12 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $575.44
| Professional | | $229.09 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $83.18
| Professional | 26 | $38.90 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $489.78
| Professional | TC | $186.21 | $275.42 | $489.78 |