- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $102.33 / $112.20
| Facility | 26 | $100.00 | $102.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $758.58
| Professional | | $204.17 | $281.84 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $380.19
| Professional | 26 | $109.65 | $154.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $223.87
| Professional | TC | $93.33 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $302.00
| Professional | 26 | $147.91 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $263.03 / $407.38
| Professional | | $141.25 | $263.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $338.84 / $467.74
| Professional | | $281.84 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $154.88 / $154.88
| Professional | 26 | $144.54 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $331.13 / $549.54
| Professional | | $245.47 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $302.00
| Professional | 26 | $128.82 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $263.03
| Professional | TC | $114.82 | $154.88 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | 26 | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,454.71 / $2,454.71
| Professional | | $1,778.28 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $954.99 / $1,258.93 / $1,258.93
| Professional | 26 | $954.99 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $831.76 / $1,174.90 / $1,174.90
| Professional | TC | $831.76 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $112.20 / $204.17
| Facility | 26 | $102.33 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $407.38 / $707.95
| Professional | | $208.93 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $218.78 / $346.74
| Professional | 26 | $112.20 | $218.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $194.98 / $323.59
| Professional | TC | $97.72 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $109.65 / $239.88
| Professional | | $32.36 | $109.65 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $549.54
| Professional | | $436.52 | $512.86 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $316.23 / $524.81
| Professional | | $245.47 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $288.40
| Professional | 26 | $128.82 | $173.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $245.47
| Professional | TC | $112.20 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $354.81 / $467.74
| Professional | | $245.47 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $190.55 / $245.47
| Professional | 26 | $131.83 | $190.55 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $169.82 / $218.78
| Professional | TC | $117.49 | $169.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $288.40 / $288.40
| Professional | | $281.84 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $154.88 / $154.88
| Professional | 26 | $147.91 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $138.04 / $138.04
| Professional | TC | $131.83 | $138.04 | $138.04 |