- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $245.47
| Facility | 26 | $112.20 | $223.87 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $549.54
| Professional | | $204.17 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $120.23 / $288.40
| Professional | 26 | $54.95 | $120.23 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $275.42
| Professional | TC | $97.72 | $125.89 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | 26 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,000.00 / $1,258.93
| Professional | | $446.68 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $331.13
| Professional | 26 | $117.49 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $741.31 / $933.25
| Professional | TC | $257.04 | $741.31 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $691.83 / $1,258.93
| Professional | | $363.08 | $691.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $295.12
| Professional | 26 | $104.71 | $154.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $407.38 / $758.58
| Professional | TC | $269.15 | $407.38 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $831.76 / $1,071.52 / $1,071.52
| Facility | 26 | $831.76 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $575.44 / $1,905.46
| Professional | | $398.11 | $575.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $724.44
| Professional | 26 | $109.65 | $151.36 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $1,445.44
| Professional | TC | $281.84 | $457.09 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $524.81 / $1,174.90
| Professional | | $436.52 | $524.81 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $281.84 / $354.81
| Professional | 26 | $229.09 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $251.19 / $870.96
| Professional | TC | $204.17 | $251.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | 26 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $575.44 / $1,174.90
| Professional | | $524.81 | $575.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $309.03
| Professional | 26 | $229.09 | $269.15 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $338.84 / $870.96
| Professional | TC | $257.04 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $575.44 / $1,096.48
| Professional | | $407.38 | $575.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $302.00
| Professional | 26 | $109.65 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $416.87 / $794.33
| Professional | TC | $288.40 | $416.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $933.25
| Professional | | $794.33 | $794.33 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $257.04
| Professional | 26 | $218.78 | $218.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $691.83
| Professional | TC | $588.84 | $588.84 | $691.83 |