- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $371.54
| Facility | 26 | $123.03 | $173.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $575.44
| Professional | | $204.17 | $275.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $251.19
| Professional | 26 | $87.10 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $281.84
| Professional | TC | $100.00 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $575.44
| Professional | | $186.21 | $234.42 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $229.09
| Professional | 26 | $97.72 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $331.13
| Professional | TC | $89.13 | $112.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $316.23
| Professional | | $147.91 | $165.96 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $128.82 / $186.21
| Facility | 26 | $27.54 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $645.65 / $1,380.38
| Professional | | $323.59 | $645.65 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $416.87
| Professional | 26 | $83.18 | $162.18 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $1,047.13
| Professional | TC | $245.47 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $457.09
| Professional | | $229.09 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $416.87
| Professional | 26 | $112.20 | $158.49 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $223.87
| Professional | TC | $114.82 | $154.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $371.54 / $977.24
| Professional | | $177.83 | $371.54 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $281.84
| Professional | 26 | $104.71 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $177.83 / $707.95
| Professional | TC | $87.10 | $177.83 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $954.99
| Professional | | $229.09 | $302.00 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $162.18
| Professional | 26 | $138.04 | $138.04 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $645.65 / $1,122.02
| Professional | | $549.54 | $645.65 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $165.96 / $302.00
| Professional | 26 | $134.90 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $489.78 / $812.83
| Professional | TC | $416.87 | $489.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $371.54 / $1,258.93
| Professional | | $223.87 | $371.54 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $489.78
| Professional | 26 | $100.00 | $151.36 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $223.87 / $724.44
| Professional | TC | $125.89 | $223.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $269.15
| Facility | 26 | $93.33 | $131.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $331.13 / $741.31
| Professional | | $177.83 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $165.96 / $288.40
| Professional | 26 | $95.50 | $165.96 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $169.82 / $467.74
| Professional | TC | $85.11 | $169.82 | $467.74 |