- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $107.15
| Facility | 26 | $52.48 | $57.54 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $281.84
| Professional | | $138.04 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $60.26 / $102.33
| Professional | 26 | $52.48 | $60.26 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $109.65 / $173.78
| Professional | TC | $87.10 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $125.89 / $269.15
| Professional | | $53.70 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $60.26
| Professional | 26 | $54.95 | $57.54 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $66.07 / $93.33
| Facility | 26 | $14.13 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $660.69
| Professional | | $275.42 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $128.82
| Professional | 26 | $56.23 | $74.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $537.03
| Professional | TC | $223.87 | $316.23 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | 26 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,778.28
| Professional | | $1,445.44 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $467.74
| Professional | 26 | $371.54 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,445.44
| Professional | TC | $1,122.02 | $1,122.02 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $107.15
| Facility | 26 | $52.48 | $74.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $218.78 / $549.54
| Professional | | $151.36 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $131.83
| Professional | 26 | $52.48 | $72.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $416.87
| Professional | TC | $95.50 | $141.25 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $234.42
| Professional | | $32.36 | $38.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $288.40 / $676.08
| Professional | | $63.10 | $288.40 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $69.18 / $97.72
| Facility | 26 | $14.79 | $69.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $676.08
| Professional | | $275.42 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $117.49
| Professional | 26 | $56.23 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $501.19
| Professional | TC | $223.87 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $537.03
| Professional | | $263.03 | $331.13 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $104.71
| Professional | 26 | $48.98 | $64.57 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $269.15 / $436.52
| Professional | TC | $208.93 | $269.15 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $165.96 / $199.53
| Professional | | $158.49 | $165.96 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $58.88 / $70.79
| Professional | 26 | $57.54 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $107.15 / $125.89
| Professional | TC | $102.33 | $107.15 | $125.89 |