- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $323.59
| Facility | 26 | $223.87 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $524.81 / $1,096.48
| Professional | | $363.08 | $524.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $269.15
| Professional | 26 | $85.11 | $144.54 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $371.54 / $812.83
| Professional | TC | $263.03 | $371.54 | $812.83 |
- 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
- $602.56 / $645.65 / $891.25
| Professional | | $602.56 | $645.65 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $162.18 / $223.87
| Professional | 26 | $138.04 | $162.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $478.63 / $660.69
| Professional | TC | $457.09 | $478.63 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $524.81 / $1,122.02
| Professional | | $295.12 | $524.81 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $186.21
| Professional | 26 | $70.79 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $398.11 / $977.24
| Professional | TC | $223.87 | $398.11 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,511.89
| Professional | | $2,238.72 | $2,238.72 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $691.83 / $812.83 / $812.83
| Professional | 26 | $691.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,819.70
| Professional | TC | $1,412.54 | $1,412.54 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $323.59
| Facility | 26 | $223.87 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $676.08 / $1,202.26
| Professional | | $478.63 | $676.08 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $257.04
| Professional | 26 | $117.49 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $933.25
| Professional | TC | $354.81 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $229.09
| Professional | | $32.36 | $33.11 | $229.09 |
- 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 / $724.44 / $870.96
| Professional | | $524.81 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $208.93
| Professional | 26 | $138.04 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $645.65
| Professional | TC | $398.11 | $562.34 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $323.59 / $1,737.80
| Professional | | $316.23 | $323.59 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $190.55
| Professional | 26 | $79.43 | $79.43 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $269.15 / $912.01
| Professional | TC | $239.88 | $269.15 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $645.65 / $1,230.27
| Professional | | $338.84 | $645.65 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $173.78
| Professional | 26 | $74.13 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $575.44 / $1,122.02
| Professional | TC | $257.04 | $575.44 | $1,122.02 |