- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $281.84
| Facility | 26 | $112.20 | $128.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $524.81 / $1,995.26
| Professional | | $309.03 | $524.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $389.05
| Professional | 26 | $97.72 | $165.96 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $870.96
| Professional | TC | $239.88 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $275.42
| Professional | | $234.42 | $251.19 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $58.88 / $138.04
| Professional | 26 | $57.54 | $58.88 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $436.52 / $1,445.44
| Professional | | $346.74 | $436.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $234.42
| Professional | 26 | $95.50 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $309.03 / $933.25
| Professional | TC | $251.19 | $309.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $389.05 / $537.03
| Professional | | $151.36 | $389.05 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $120.23 / $169.82
| Facility | 26 | $25.70 | $120.23 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $851.14 / $3,090.30
| Professional | | $346.74 | $851.14 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $154.88 / $389.05
| Professional | 26 | $81.28 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $602.56 / $2,398.83
| Professional | TC | $239.88 | $602.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $478.63 / $758.58
| Professional | | $354.81 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $144.54 / $446.68
| Professional | 26 | $102.33 | $144.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $512.86
| Professional | TC | $251.19 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $549.54 / $794.33
| Professional | | $316.23 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $165.96 / $239.88
| Professional | 26 | $85.11 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $549.54
| Professional | TC | $218.78 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $158.49
| Professional | 26 | $91.20 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $467.74 / $870.96
| Professional | | $426.58 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $131.83 / $218.78
| Professional | 26 | $123.03 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $724.44 / $1,047.13
| Professional | | $467.74 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $275.42
| Professional | 26 | $134.90 | $208.93 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $524.81 / $676.08
| Professional | TC | $346.74 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $2,344.23
| Professional | | $316.23 | $512.86 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $676.08
| Professional | 26 | $93.33 | $138.04 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $363.08 / $1,949.84
| Professional | TC | $239.88 | $363.08 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $354.81
| Facility | 26 | $85.11 | $120.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $537.03 / $1,000.00
| Professional | | $316.23 | $537.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $151.36 / $275.42
| Professional | 26 | $85.11 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $389.05 / $691.83
| Professional | TC | $218.78 | $389.05 | $691.83 |