- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $323.59 / $398.11
| Facility | 26 | $288.40 | $323.59 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $1,047.13
| Professional | | $194.98 | $331.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $97.72 / $302.00
| Professional | 26 | $54.95 | $97.72 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $218.78 / $630.96
| Professional | TC | $125.89 | $218.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $912.01 / $1,174.90
| Professional | | $416.87 | $912.01 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $173.78 / $309.03
| Professional | 26 | $75.86 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $645.65 / $891.25
| Professional | TC | $316.23 | $645.65 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $323.59 / $398.11
| Facility | 26 | $288.40 | $323.59 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $851.14 / $1,862.09
| Professional | | $346.74 | $851.14 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $263.03 / $645.65
| Professional | 26 | $100.00 | $263.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $616.60 / $1,258.93
| Professional | TC | $245.47 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,348.96 / $2,238.72
| Professional | | $1,318.26 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $354.81 / $588.84
| Professional | 26 | $323.59 | $354.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $870.96 / $977.24 / $1,621.81
| Professional | TC | $870.96 | $977.24 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $831.76 / $1,047.13
| Professional | | $478.63 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $173.78 / $302.00
| Professional | 26 | $75.86 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $645.65 / $794.33
| Professional | TC | $245.47 | $645.65 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $2,041.74
| Professional | | $363.08 | $851.14 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $263.03 / $630.96
| Professional | 26 | $100.00 | $263.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $630.96 / $1,412.54
| Professional | TC | $245.47 | $630.96 | $1,412.54 |