- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $177.83 / $186.21
| Facility | 26 | $89.13 | $177.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $426.58 / $1,819.70
| Professional | | $281.84 | $426.58 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $302.00
| Professional | 26 | $85.11 | $128.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $501.19
| Professional | TC | $194.98 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $676.08 / $933.25
| Professional | | $389.05 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $199.53 / $257.04
| Professional | 26 | $91.20 | $199.53 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $467.74 / $776.25
| Professional | TC | $269.15 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $537.03 / $1,995.26
| Professional | | $251.19 | $537.03 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $154.88 / $562.34
| Professional | 26 | $79.43 | $154.88 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $389.05 / $1,548.82
| Professional | TC | $173.78 | $389.05 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $794.33 / $794.33
| Facility | 26 | $616.60 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $645.65 / $3,467.37
| Professional | | $346.74 | $645.65 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $645.65
| Professional | 26 | $91.20 | $131.83 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $3,019.95
| Professional | TC | $229.09 | $478.63 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $707.95 / $1,122.02
| Professional | | $549.54 | $707.95 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $263.03
| Professional | 26 | $169.82 | $208.93 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $501.19 / $912.01
| Professional | TC | $380.19 | $501.19 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $870.96 / $977.24
| Professional | | $660.69 | $870.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $208.93 / $288.40
| Professional | 26 | $165.96 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $616.60 / $812.83
| Professional | TC | $457.09 | $616.60 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $467.74
| Professional | | $87.10 | $194.98 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $1,000.00
| Professional | | $316.23 | $512.86 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $295.12
| Professional | 26 | $91.20 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $707.95
| Professional | TC | $223.87 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $741.31
| Professional | | $630.96 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $223.87
| Professional | 26 | $190.55 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $512.86
| Professional | TC | $436.52 | $436.52 | $512.86 |