- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $141.25
| Facility | 26 | $100.00 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $467.74 / $851.14
| Professional | | $363.08 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $724.44
| Professional | 26 | $56.23 | $100.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $407.38 / $691.83
| Professional | TC | $302.00 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $676.08 / $2,511.89
| Professional | | $426.58 | $676.08 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $380.19
| Professional | 26 | $66.07 | $102.33 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $575.44 / $2,137.96
| Professional | TC | $363.08 | $575.44 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $331.13
| Facility | 26 | $173.78 | $204.17 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,548.82 / $1,778.28
| Professional | | $660.69 | $1,548.82 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $239.88 / $275.42
| Professional | 26 | $100.00 | $239.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $1,318.26 / $1,513.56
| Professional | TC | $562.34 | $1,318.26 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,000.00 / $1,202.26
| Professional | | $851.14 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $154.88 / $186.21
| Professional | 26 | $131.83 | $154.88 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $1,000.00
| Professional | TC | $707.95 | $831.76 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $977.24 / $2,951.21
| Professional | | $512.86 | $977.24 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $144.54 / $426.58
| Professional | 26 | $77.62 | $144.54 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $831.76 / $2,511.89
| Professional | TC | $436.52 | $831.76 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $724.44 / $2,290.87
| Professional | | $691.83 | $724.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $114.82 / $251.19
| Professional | 26 | $97.72 | $114.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $616.60 / $2,041.74
| Professional | TC | $588.84 | $616.60 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,000.00 / $1,479.11
| Professional | | $660.69 | $1,000.00 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $426.58 / $426.58
| Facility | 26 | $154.88 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,398.83 / $2,951.21
| Professional | | $691.83 | $2,398.83 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $354.81 / $426.58
| Professional | 26 | $109.65 | $354.81 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $2,041.74 / $2,511.89
| Professional | TC | $575.44 | $2,041.74 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,174.90 / $1,174.90
| Professional | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Professional | 26 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | TC | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $2,754.23 / $3,630.78
| Professional | | $1,148.15 | $2,754.23 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $186.21 / $323.59
| Professional | 26 | $158.49 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $1,096.48 / $1,949.84
| Professional | TC | $933.25 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $870.96 / $2,290.87
| Professional | | $95.50 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $173.78 / $524.81
| Professional | 26 | $79.43 | $173.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $776.25 / $1,698.24
| Professional | TC | $436.52 | $776.25 | $1,698.24 |