- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $239.88 / $407.38
| Facility | 26 | $104.71 | $239.88 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $2,630.27
| Professional | | $426.58 | $630.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $338.84
| Professional | 26 | $109.65 | $169.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $977.24
| Professional | TC | $302.00 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $123.03 / $173.78
| Facility | 26 | $26.30 | $123.03 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $891.25 / $1,621.81
| Professional | | $501.19 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $309.03
| Professional | 26 | $104.71 | $147.91 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $707.95 / $1,380.38
| Professional | TC | $398.11 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,047.13 / $1,288.25
| Professional | | $933.25 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $229.09 / $275.42
| Professional | 26 | $199.53 | $229.09 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $831.76 / $1,023.29
| Professional | TC | $724.44 | $831.76 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $239.88 / $407.38
| Facility | 26 | $104.71 | $239.88 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,698.24
| Professional | | $707.95 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $218.78 / $323.59
| Professional | 26 | $147.91 | $218.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $831.76 / $1,288.25
| Professional | TC | $501.19 | $831.76 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $426.58 / $954.99
| Professional | | $181.97 | $426.58 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,096.48 / $1,548.82
| Professional | | $537.03 | $1,096.48 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $309.03
| Professional | 26 | $104.71 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $933.25 / $1,412.54
| Professional | TC | $398.11 | $933.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 26 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,148.15 / $1,412.54
| Professional | | $912.01 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $229.09 / $302.00
| Professional | 26 | $194.98 | $229.09 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,174.90
| Professional | TC | $724.44 | $912.01 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $870.96 / $1,659.59
| Professional | | $478.63 | $870.96 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $323.59
| Professional | 26 | $97.72 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $707.95 / $1,318.26
| Professional | TC | $380.19 | $707.95 | $1,318.26 |