- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $120.23
| Facility | 26 | $60.26 | $91.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $467.74 / $2,187.76
| Professional | | $363.08 | $467.74 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $79.43 / $213.80
| Professional | 26 | $57.54 | $79.43 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $933.25
| Professional | TC | $302.00 | $398.11 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,023.29 / $1,288.25
| Professional | | $977.24 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $154.88 / $194.98
| Professional | 26 | $147.91 | $154.88 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $831.76 / $870.96 / $1,096.48
| Professional | TC | $831.76 | $870.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $630.96 / $2,344.23
| Professional | | $416.87 | $630.96 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $102.33 / $309.03
| Professional | 26 | $70.79 | $102.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $524.81 / $2,089.30
| Professional | TC | $363.08 | $524.81 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $302.00
| Facility | 26 | $204.17 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $691.83 / $1,737.80
| Professional | | $446.68 | $691.83 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $85.11 / $251.19
| Professional | 26 | $69.18 | $85.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $467.74 / $1,479.11
| Professional | TC | $371.54 | $467.74 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $912.01 / $1,862.09
| Professional | | $851.14 | $912.01 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $141.25 / $281.84
| Professional | 26 | $123.03 | $141.25 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $758.58 / $1,584.89
| Professional | TC | $707.95 | $758.58 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $208.93
| Facility | 26 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,122.02
| Professional | | $1,000.00 | $1,000.00 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $165.96
| Professional | 26 | $154.88 | $154.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $954.99
| Professional | TC | $851.14 | $851.14 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $562.34 / $1,122.02
| Professional | | $457.09 | $562.34 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $169.82
| Professional | 26 | $70.79 | $81.28 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $467.74 / $933.25
| Professional | TC | $389.05 | $467.74 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $851.14
| Professional | | $575.44 | $724.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $134.90
| Professional | 26 | $89.13 | $114.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $724.44
| Professional | TC | $489.78 | $616.60 | $724.44 |