- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $218.78
| Facility | 26 | $154.88 | $154.88 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $724.44
| Professional | | $257.04 | $363.08 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $218.78
| Professional | 26 | $74.13 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $257.04 / $478.63
| Professional | TC | $181.97 | $257.04 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $1,905.46
| Professional | | $323.59 | $512.86 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $575.44
| Professional | 26 | $100.00 | $154.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $1,348.96
| Professional | TC | $223.87 | $363.08 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $512.86
| Facility | 26 | $269.15 | $316.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $954.99 / $1,819.70
| Professional | | $380.19 | $954.99 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $537.03
| Professional | 26 | $123.03 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $676.08 / $1,258.93
| Professional | TC | $263.03 | $676.08 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $812.83 / $977.24
| Professional | | $691.83 | $812.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $239.88 / $288.40
| Professional | 26 | $208.93 | $239.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $575.44 / $691.83
| Professional | TC | $489.78 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $645.65 / $2,187.76
| Professional | | $354.81 | $645.65 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $208.93 / $645.65
| Professional | 26 | $114.82 | $208.93 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $446.68 / $1,548.82
| Professional | TC | $245.47 | $446.68 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $912.01 / $1,584.89
| Professional | | $478.63 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $275.42 / $467.74
| Professional | 26 | $144.54 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $630.96 / $1,096.48
| Professional | TC | $338.84 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $831.76 / $1,584.89
| Professional | | $426.58 | $831.76 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $645.65
| Facility | 26 | $245.47 | $245.47 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,621.81 / $2,187.76
| Professional | | $562.34 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $512.86 / $645.65
| Professional | 26 | $169.82 | $512.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $1,122.02 / $1,548.82
| Professional | TC | $398.11 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Professional | TC | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,137.96 / $2,570.40
| Professional | | $1,071.52 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $338.84 / $467.74
| Professional | 26 | $288.40 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $1,122.02
| Professional | TC | $616.60 | $724.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $616.60 / $1,445.44
| Professional | | $346.74 | $616.60 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $257.04 / $660.69
| Professional | 26 | $87.10 | $257.04 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $426.58 / $1,000.00
| Professional | TC | $234.42 | $426.58 | $1,000.00 |