- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $112.20 / $323.59
| Facility | 26 | $87.10 | $112.20 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $1,737.80
| Professional | | $269.15 | $457.09 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $346.74
| Professional | 26 | $81.28 | $104.71 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $354.81 / $1,023.29
| Professional | TC | $169.82 | $354.81 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $323.59 / $588.84
| Professional | | $154.88 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $199.53
| Professional | 26 | $66.07 | $91.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | TC | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $616.60 / $1,047.13
| Professional | | $398.11 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $251.19
| Professional | 26 | $79.43 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $501.19 / $812.83
| Professional | TC | $295.12 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $977.24
| Professional | | $354.81 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $269.15
| Professional | 26 | $104.71 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $691.83
| Professional | TC | $251.19 | $363.08 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $97.72 / $141.25
| Facility | 26 | $20.89 | $97.72 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $912.01
| Professional | | $245.47 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $218.78
| Professional | 26 | $60.26 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $346.74 / $724.44
| Professional | TC | $177.83 | $346.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $467.74
| Professional | | $269.15 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $128.82
| Professional | 26 | $79.43 | $95.50 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $338.84
| Professional | TC | $190.55 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $346.74 / $630.96
| Professional | | $275.42 | $346.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $109.65 / $177.83
| Professional | 26 | $83.18 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $524.81
| Professional | TC | $229.09 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Facility | 26 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $3,311.31 / $3,311.31
| Professional | | $446.68 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $1,000.00
| Professional | 26 | $691.83 | $691.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,754.23 / $2,754.23 / $2,754.23
| Professional | TC | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $102.33 / $331.13
| Professional | | $32.36 | $102.33 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $501.19 / $831.76
| Professional | | $251.19 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $100.00 / $177.83
| Professional | 26 | $54.95 | $100.00 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $323.59 / $691.83
| Professional | TC | $169.82 | $323.59 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | 26 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Professional | TC | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $354.81 / $457.09
| Professional | | $269.15 | $354.81 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $1,000.00
| Professional | | $257.04 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $295.12
| Professional | 26 | $72.44 | $95.50 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $302.00 / $645.65
| Professional | TC | $181.97 | $302.00 | $645.65 |