- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $186.21 / $446.68
| Facility | 26 | $100.00 | $186.21 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $354.81 / $741.31
| Professional | | $269.15 | $354.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $331.13
| Professional | 26 | $100.00 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $489.78
| Professional | TC | $162.18 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $537.03 / $870.96
| Professional | | $380.19 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $229.09
| Professional | 26 | $104.71 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $398.11 / $630.96
| Professional | TC | $269.15 | $398.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $524.81 / $2,238.72
| Professional | | $144.54 | $524.81 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $218.78
| Professional | 26 | $112.20 | $151.36 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $446.68 / $616.60
| Professional | TC | $398.11 | $446.68 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $602.56 / $1,071.52
| Professional | | $346.74 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $234.42
| Professional | 26 | $87.10 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $457.09 / $812.83
| Professional | TC | $251.19 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $630.96
| Professional | | $407.38 | $489.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $125.89 / $158.49
| Professional | 26 | $102.33 | $125.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $478.63
| Professional | TC | $295.12 | $363.08 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,096.48 / $1,096.48
| Professional | | $891.25 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $239.88
| Professional | 26 | $169.82 | $208.93 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $467.74
| Professional | | $275.42 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $426.58 / $1,949.84
| Professional | | $144.54 | $426.58 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $154.88 / $245.47
| Professional | 26 | $117.49 | $154.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $338.84 / $588.84
| Professional | TC | $177.83 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $1,071.52
| Professional | | $338.84 | $562.34 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $131.83 / $239.88
| Professional | 26 | $77.62 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $416.87 / $851.14
| Professional | TC | $257.04 | $416.87 | $851.14 |