- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $190.55 / $281.84
| Facility | 26 | $165.96 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $1,819.70
| Professional | | $257.04 | $467.74 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $676.08
| Professional | 26 | $77.62 | $104.71 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $239.88 / $512.86
| Professional | TC | $169.82 | $239.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $1,621.81
| Professional | | $281.84 | $436.52 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $489.78
| Professional | 26 | $83.18 | $131.83 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $1,148.15
| Professional | TC | $199.53 | $316.23 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $239.88 / $354.81
| Professional | | $109.65 | $239.88 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $416.87
| Facility | 26 | $223.87 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $1,174.90
| Professional | | $316.23 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $204.17 / $346.74
| Professional | 26 | $95.50 | $204.17 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $549.54 / $831.76
| Professional | TC | $223.87 | $549.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $630.96 / $851.14
| Professional | | $524.81 | $630.96 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $257.04
| Professional | 26 | $158.49 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $446.68 / $602.56
| Professional | TC | $371.54 | $446.68 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $575.44 / $812.83 / $812.83
| Facility | 26 | $575.44 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $724.44 / $3,162.28
| Professional | | $354.81 | $724.44 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $281.84 / $1,000.00
| Professional | 26 | $104.71 | $281.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $524.81 / $2,691.53
| Professional | TC | $245.47 | $524.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $467.74
| Professional | | $32.36 | $33.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $707.95 / $1,122.02
| Professional | | $354.81 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $323.59
| Professional | 26 | $123.03 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $562.34 / $831.76
| Professional | TC | $295.12 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $1,258.93
| Professional | | $371.54 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $794.33 / $794.33
| Facility | 26 | $199.53 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,819.70 / $3,311.31
| Professional | | $389.05 | $1,819.70 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $446.68 / $1,000.00
| Professional | 26 | $109.65 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $1,513.56 / $2,754.23
| Professional | TC | $275.42 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | 26 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | TC | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,659.59 / $2,089.30
| Professional | | $977.24 | $1,659.59 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $302.00 / $512.86
| Professional | 26 | $269.15 | $302.00 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $741.31 / $1,258.93
| Professional | TC | $676.08 | $741.31 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $1,148.15 / $2,238.72
| Professional | | $95.50 | $1,148.15 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $436.52 / $660.69
| Professional | 26 | $87.10 | $436.52 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $416.87 / $933.25
| Professional | TC | $213.80 | $416.87 | $933.25 |