- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $147.91 / $389.05
| Facility | 26 | $131.83 | $147.91 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $524.81 / $1,230.27
| Professional | | $363.08 | $524.81 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $389.05
| Professional | 26 | $102.33 | $165.96 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $758.58
| Professional | TC | $251.19 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $630.96 / $870.96
| Professional | | $575.44 | $630.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $269.15
| Professional | 26 | $162.18 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $407.38 / $436.52 / $602.56
| Professional | TC | $407.38 | $436.52 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $478.63 / $1,047.13
| Professional | | $295.12 | $478.63 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $117.49 / $213.80
| Professional | 26 | $85.11 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $851.14
| Professional | TC | $208.93 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,398.83 / $2,398.83
| Professional | | $1,230.27 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Professional | 26 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $1,659.59 / $1,659.59
| Professional | TC | $501.19 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $338.84 / $389.05
| Facility | 26 | $131.83 | $338.84 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $1,230.27
| Professional | | $478.63 | $660.69 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $323.59
| Professional | 26 | $128.82 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $467.74 / $870.96
| Professional | TC | $338.84 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $223.87
| Professional | | $32.36 | $33.11 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $707.95 / $851.14
| Professional | | $524.81 | $707.95 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $204.17 / $245.47
| Professional | 26 | $165.96 | $204.17 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $512.86 / $602.56
| Professional | TC | $371.54 | $512.86 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $323.59 / $1,230.27
| Professional | | $316.23 | $323.59 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $234.42
| Professional | 26 | $95.50 | $95.50 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $245.47 / $912.01
| Professional | TC | $218.78 | $245.47 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $1,148.15
| Professional | | $338.84 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $204.17
| Professional | 26 | $89.13 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $1,000.00
| Professional | TC | $245.47 | $467.74 | $1,000.00 |