- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $338.84
| Facility | 26 | $83.18 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $1,778.28
| Professional | | $281.84 | $457.09 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $151.36 / $407.38
| Professional | 26 | $85.11 | $151.36 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $707.95
| Professional | TC | $194.98 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $537.03 / $537.03
| Facility | 26 | $199.53 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $588.84 / $3,630.78
| Professional | | $323.59 | $588.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $660.69
| Professional | 26 | $77.62 | $117.49 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $3,090.30
| Professional | TC | $234.42 | $478.63 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $977.24 / $1,479.11
| Professional | | $562.34 | $977.24 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $218.78
| Professional | 26 | $97.72 | $165.96 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $602.56 / $1,000.00
| Professional | | $245.47 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $125.89 / $251.19
| Professional | 26 | $70.79 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $467.74 / $794.33
| Professional | TC | $190.55 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $281.84 / $549.54
| Professional | | $104.71 | $281.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $467.74 / $870.96
| Professional | | $302.00 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $229.09
| Professional | 26 | $85.11 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $537.03
| Professional | TC | $208.93 | $316.23 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $724.44
| Professional | | $676.08 | $676.08 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $537.03 / $537.03
| Facility | 26 | $199.53 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $588.84 / $3,630.78
| Professional | | $323.59 | $588.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $660.69
| Professional | 26 | $77.62 | $117.49 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $3,090.30
| Professional | TC | $234.42 | $478.63 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $1,023.29
| Professional | | $323.59 | $537.03 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $281.84
| Professional | 26 | $87.10 | $123.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $812.83
| Professional | TC | $229.09 | $371.54 | $812.83 |