- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $134.90 / $295.12
| Facility | 26 | $117.49 | $134.90 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $512.86 / $2,290.87
| Professional | | $309.03 | $512.86 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $489.78
| Professional | 26 | $85.11 | $141.25 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $758.58
| Professional | TC | $223.87 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $169.82 / $190.55
| Professional | 26 | $77.62 | $169.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $1,174.90
| Professional | | $549.54 | $851.14 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $309.03
| Professional | 26 | $144.54 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $933.25
| Professional | TC | $407.38 | $630.96 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $724.44 / $1,258.93
| Professional | | $371.54 | $724.44 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $162.18 / $309.03
| Professional | 26 | $87.10 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $562.34 / $977.24
| Professional | TC | $263.03 | $562.34 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $1,000.00
| Facility | 26 | $123.03 | $204.17 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $794.33 / $1,096.48
| Professional | | $467.74 | $794.33 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $263.03
| Professional | 26 | $102.33 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $831.76
| Professional | TC | $338.84 | $602.56 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $181.97
| Professional | | $32.36 | $33.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $263.03 / $630.96
| Professional | | $112.20 | $263.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $141.25
| Facility | 26 | $138.04 | $138.04 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $831.76 / $1,122.02
| Professional | | $537.03 | $831.76 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $213.80 / $302.00
| Professional | 26 | $141.25 | $213.80 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $616.60 / $831.76
| Professional | TC | $398.11 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $831.76 / $1,174.90
| Professional | | $549.54 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $218.78 / $295.12
| Professional | 26 | $144.54 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $407.38 / $616.60 / $851.14
| Professional | TC | $407.38 | $616.60 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $537.03 / $1,096.48
| Professional | | $331.13 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $123.03 / $295.12
| Professional | 26 | $89.13 | $123.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $794.33
| Professional | TC | $239.88 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $457.09 / $851.14
| Professional | | $446.68 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $117.49 / $208.93
| Professional | 26 | $109.65 | $117.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $645.65
| Professional | TC | $338.84 | $338.84 | $645.65 |