- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $125.89
| Facility | 26 | $114.82 | $114.82 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $537.03
| Professional | | $208.93 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $158.49
| Professional | 26 | $57.54 | $77.62 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $389.05
| Professional | TC | $151.36 | $208.93 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $1,258.93
| Professional | | $213.80 | $407.38 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $104.71 / $338.84
| Professional | 26 | $58.88 | $104.71 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $912.01
| Professional | TC | $154.88 | $309.03 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $181.97 / $295.12
| Facility | 26 | $158.49 | $181.97 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $616.60 / $891.25
| Professional | | $288.40 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $141.25 / $245.47
| Professional | 26 | $66.07 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $426.58 / $630.96
| Professional | TC | $213.80 | $426.58 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $758.58
| Professional | | $389.05 | $467.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $186.21
| Professional | 26 | $109.65 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $575.44
| Professional | TC | $281.84 | $338.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Facility | 26 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $2,238.72
| Professional | | $288.40 | $575.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $141.25 / $588.84
| Professional | 26 | $70.79 | $141.25 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $446.68 / $1,819.70
| Professional | TC | $213.80 | $446.68 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $426.58
| Professional | | $32.36 | $33.11 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $630.96 / $977.24
| Professional | | $269.15 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $151.36 / $251.19
| Professional | 26 | $85.11 | $151.36 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $794.33
| Professional | TC | $234.42 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $1,122.02
| Professional | | $275.42 | $524.81 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $549.54 / $549.54
| Facility | 26 | $138.04 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $1,288.25 / $2,238.72
| Professional | | $323.59 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $309.03 / $588.84
| Professional | 26 | $87.10 | $309.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $1,047.13 / $1,819.70
| Professional | TC | $234.42 | $1,047.13 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | 26 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | TC | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,288.25 / $1,819.70
| Professional | | $977.24 | $1,288.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $257.04 / $363.08
| Professional | 26 | $213.80 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $741.31 / $1,000.00
| Professional | TC | $549.54 | $741.31 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $478.63 / $933.25
| Professional | | $257.04 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $275.42 / $457.09
| Professional | 26 | $87.10 | $275.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $363.08 / $724.44
| Professional | TC | $186.21 | $363.08 | $724.44 |