- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $346.74 / $660.69
| Facility | 26 | $213.80 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $691.83 / $2,630.27
| Professional | | $389.05 | $691.83 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $446.68 / $1,148.15
| Professional | 26 | $213.80 | $446.68 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $1,819.70
| Professional | TC | $213.80 | $363.08 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | 26 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,174.90 / $1,445.44
| Professional | | $1,047.13 | $1,174.90 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $537.03 / $676.08
| Professional | 26 | $489.78 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $630.96 / $794.33
| Professional | TC | $549.54 | $630.96 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $812.83 / $3,548.13
| Professional | | $426.58 | $812.83 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $1,318.26
| Professional | 26 | $234.42 | $380.19 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $2,398.83
| Professional | TC | $251.19 | $446.68 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $741.31 / $1,318.26 / $1,318.26
| Facility | 26 | $741.31 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,000.00 / $5,370.32
| Professional | | $537.03 | $1,000.00 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $1,698.24
| Professional | 26 | $245.47 | $302.00 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $6,165.95
| Professional | TC | $263.03 | $398.11 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,122.02 / $4,677.35
| Professional | | $954.99 | $1,122.02 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $524.81 / $812.83
| Professional | 26 | $446.68 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $3,890.45
| Professional | TC | $489.78 | $588.84 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | 26 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,288.25
| Professional | | $1,148.15 | $1,148.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $602.56
| Professional | 26 | $537.03 | $537.03 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $676.08
| Professional | TC | $602.56 | $602.56 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $426.58 / $831.76
| Professional | | $234.42 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $1,479.11
| Professional | | $467.74 | $691.83 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $512.86
| Professional | 26 | $229.09 | $288.40 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $1,202.26
| Professional | TC | $263.03 | $338.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $891.25 / $1,047.13
| Professional | | $707.95 | $891.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $489.78
| Professional | 26 | $331.13 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $478.63 / $562.34
| Professional | TC | $380.19 | $478.63 | $562.34 |