- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $91.20 / $107.15
| Facility | 26 | $67.61 | $91.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $501.19 / $1,348.96
| Professional | | $398.11 | $501.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $131.83
| Professional | 26 | $36.31 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $436.52 / $870.96
| Professional | TC | $354.81 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $831.76 / $1,174.90
| Professional | | $616.60 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $123.03
| Professional | 26 | $61.66 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,047.13
| Professional | TC | $549.54 | $758.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $977.24
| Professional | | $776.25 | $912.01 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $100.00
| Professional | 26 | $77.62 | $95.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $812.83 / $891.25
| Professional | TC | $707.95 | $812.83 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $87.10 / $107.15
| Facility | 26 | $67.61 | $87.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $891.25 / $1,288.25
| Professional | | $501.19 | $891.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $95.50 / $138.04
| Professional | 26 | $45.71 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $794.33 / $1,202.26
| Professional | TC | $436.52 | $794.33 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $831.76
| Professional | | $81.28 | $104.71 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $977.24 / $1,148.15
| Professional | | $660.69 | $977.24 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $120.23
| Professional | 26 | $60.26 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $794.33 / $1,047.13
| Professional | TC | $549.54 | $794.33 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $1,513.56
| Facility | 26 | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $977.24 / $1,202.26
| Professional | | $831.76 | $977.24 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $100.00 / $123.03
| Professional | 26 | $81.28 | $100.00 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $1,071.52
| Professional | TC | $741.31 | $870.96 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $407.38 / $1,288.25
| Professional | | $389.05 | $407.38 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $128.82
| Professional | 26 | $38.90 | $38.90 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $363.08 / $1,174.90
| Professional | TC | $346.74 | $363.08 | $1,174.90 |