- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $194.98
| Facility | 26 | $97.72 | $151.36 | $194.98 |
- 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
- $97.72 / $213.80 / $602.56
| Professional | 26 | $97.72 | $213.80 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $977.24
| Professional | TC | $208.93 | $275.42 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $831.76 / $1,047.13
| Professional | | $426.58 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $316.23
| Professional | 26 | $123.03 | $251.19 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $575.44 / $724.44
| Professional | TC | $288.40 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $602.56 / $1,995.26
| Professional | | $338.84 | $602.56 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $199.53 / $478.63
| Professional | 26 | $112.20 | $199.53 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $1,122.02
| Professional | TC | $213.80 | $323.59 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $1,023.29 / $1,023.29
| Facility | 26 | $794.33 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $831.76 / $2,344.23
| Professional | | $416.87 | $831.76 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $169.82 / $691.83
| Professional | 26 | $87.10 | $169.82 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $676.08 / $1,659.59
| Professional | TC | $288.40 | $676.08 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $891.25 / $1,513.56
| Professional | | $691.83 | $891.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $446.68
| Professional | 26 | $213.80 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $630.96 / $1,071.52
| Professional | TC | $467.74 | $630.96 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $831.76 / $1,513.56
| Professional | | $691.83 | $831.76 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $446.68
| Professional | 26 | $218.78 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $575.44 / $1,071.52
| Professional | TC | $467.74 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $239.88 / $575.44
| Professional | | $109.65 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $645.65 / $2,041.74
| Professional | | $407.38 | $645.65 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $186.21 / $338.84
| Professional | 26 | $93.33 | $186.21 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $1,071.52
| Professional | TC | $269.15 | $457.09 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $912.01
| Professional | | $776.25 | $776.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $288.40
| Professional | 26 | $245.47 | $245.47 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $630.96
| Professional | TC | $537.03 | $537.03 | $630.96 |