- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $257.04
| Facility | 26 | $112.20 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $524.81 / $1,862.09
| Professional | | $331.13 | $524.81 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $467.74
| Professional | 26 | $100.00 | $165.96 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $239.88
| Professional | 52 | $165.96 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $870.96
| Professional | TC | $218.78 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $234.42 / $309.03
| Professional | | $223.87 | $234.42 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $162.18
| Professional | 26 | $60.26 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $1,412.54
| Professional | | $323.59 | $407.38 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $125.89 / $239.88
| Professional | 26 | $100.00 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $281.84 / $831.76
| Professional | TC | $223.87 | $281.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $338.84 / $501.19
| Professional | | $158.49 | $338.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $123.03 / $177.83
| Facility | 26 | $26.30 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $724.44 / $4,168.69
| Professional | | $302.00 | $724.44 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $398.11
| Professional | 26 | $83.18 | $162.18 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $524.81 / $2,398.83
| Professional | TC | $208.93 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $724.44
| Professional | | $331.13 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $338.84
| Professional | 26 | $107.15 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $309.03 / $467.74
| Professional | TC | $229.09 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $741.31
| Professional | | $302.00 | $524.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $251.19
| Professional | 26 | $89.13 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $501.19
| Professional | TC | $199.53 | $371.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $100.00 / $162.18
| Professional | 26 | $79.43 | $100.00 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | TC | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $436.52 / $812.83
| Professional | | $338.84 | $436.52 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $234.42
| Professional | 26 | $120.23 | $138.04 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Professional | TC | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $724.44 / $1,047.13
| Professional | | $446.68 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $288.40
| Professional | 26 | $141.25 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $676.08
| Professional | TC | $309.03 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $467.74 / $2,187.76
| Professional | | $295.12 | $467.74 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $141.25 / $691.83
| Professional | 26 | $95.50 | $141.25 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $2,137.96
| Professional | TC | $213.80 | $323.59 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $371.54
| Facility | 26 | $89.13 | $125.89 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $933.25
| Professional | | $302.00 | $524.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $275.42
| Professional | 26 | $89.13 | $158.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $630.96
| Professional | TC | $199.53 | $363.08 | $630.96 |