- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $407.38
| Facility | 26 | $100.00 | $141.25 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $436.52 / $2,187.76
| Professional | | $186.21 | $436.52 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $213.80 / $537.03
| Professional | 26 | $100.00 | $213.80 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $1,548.82
| Professional | TC | $245.47 | $354.81 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $645.65 / $645.65
| Facility | 26 | $239.88 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $758.58 / $6,165.95
| Professional | | $398.11 | $758.58 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $758.58
| Professional | 26 | $89.13 | $141.25 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $588.84 / $5,623.41
| Professional | TC | $295.12 | $588.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,202.26 / $1,819.70
| Professional | | $691.83 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $263.03
| Professional | 26 | $117.49 | $199.53 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $741.31 / $1,318.26
| Professional | | $354.81 | $741.31 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $302.00
| Professional | 26 | $83.18 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $1,174.90
| Professional | TC | $275.42 | $575.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $346.74 / $676.08
| Professional | | $125.89 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $575.44 / $1,047.13
| Professional | | $371.54 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $151.36 / $269.15
| Professional | 26 | $102.33 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $707.95
| Professional | TC | $257.04 | $389.05 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $831.76
| Professional | | $144.54 | $181.97 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $645.65 / $645.65
| Facility | 26 | $239.88 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $758.58 / $6,165.95
| Professional | | $398.11 | $758.58 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $758.58
| Professional | 26 | $89.13 | $141.25 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $588.84 / $5,623.41
| Professional | TC | $295.12 | $588.84 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $691.83 / $1,445.44
| Professional | | $389.05 | $691.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $323.59
| Professional | 26 | $97.72 | $144.54 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $1,047.13
| Professional | TC | $281.84 | $457.09 | $1,047.13 |