- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $436.52
| Facility | 26 | $107.15 | $154.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $2,187.76
| Professional | | $331.13 | $537.03 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $204.17 / $501.19
| Professional | 26 | $102.33 | $204.17 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $354.81 / $1,318.26
| Professional | TC | $218.78 | $354.81 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $691.83 / $691.83
| Facility | 26 | $257.04 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $6,309.57
| Professional | | $371.54 | $707.95 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $912.01
| Professional | 26 | $97.72 | $151.36 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $5,754.40
| Professional | TC | $263.03 | $537.03 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,122.02 / $1,819.70
| Professional | | $645.65 | $1,122.02 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $281.84
| Professional | 26 | $123.03 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $676.08 / $1,318.26
| Professional | | $281.84 | $676.08 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $323.59
| Professional | 26 | $91.20 | $162.18 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $512.86 / $1,174.90
| Professional | TC | $213.80 | $512.86 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $323.59 / $616.60
| Professional | | $134.90 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $1,000.00
| Professional | | $331.13 | $537.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $162.18 / $288.40
| Professional | 26 | $109.65 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $645.65
| Professional | TC | $234.42 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $186.21 / $223.87
| Professional | | $154.88 | $186.21 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $691.83 / $691.83
| Facility | 26 | $257.04 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $6,309.57
| Professional | | $371.54 | $707.95 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $912.01
| Professional | 26 | $97.72 | $151.36 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $537.03 / $5,754.40
| Professional | TC | $263.03 | $537.03 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $660.69 / $1,412.54
| Professional | | $363.08 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $346.74
| Professional | 26 | $107.15 | $158.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $1,023.29
| Professional | TC | $251.19 | $407.38 | $1,023.29 |