- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $416.87 / $489.78
| Facility | 26 | $186.21 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $575.44 / $2,454.71
| Professional | | $323.59 | $575.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $407.38
| Professional | 26 | $100.00 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $338.84 / $1,096.48
| Professional | TC | $229.09 | $338.84 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $891.25 / $1,659.59
| Professional | | $363.08 | $891.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $281.84
| Professional | 26 | $102.33 | $199.53 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $602.56 / $1,348.96
| Professional | TC | $263.03 | $602.56 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,071.52 / $1,479.11
| Professional | | $489.78 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $309.03
| Professional | 26 | $104.71 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $831.76 / $1,318.26
| Professional | TC | $338.84 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,047.13 / $1,584.89
| Professional | | $524.81 | $1,047.13 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $165.96
| Professional | 26 | $114.82 | $138.04 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $398.11 / $851.14
| Professional | TC | $316.23 | $398.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $186.21 / $1,949.84
| Professional | | $151.36 | $186.21 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $1,819.70
| Professional | | $338.84 | $537.03 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $134.90 / $416.87
| Professional | 26 | $93.33 | $134.90 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $1,348.96
| Professional | TC | $239.88 | $363.08 | $1,348.96 |