- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $616.60
| Facility | 26 | $288.40 | $346.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,288.25 / $3,715.35
| Professional | | $977.24 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $933.25
| Professional | 26 | $269.15 | $389.05 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $933.25 / $1,778.28
| Professional | TC | $676.08 | $933.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,071.52 / $2,754.23
| Professional | | $851.14 | $1,071.52 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $316.23 / $812.83
| Professional | 26 | $251.19 | $316.23 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,995.26
| Professional | TC | $588.84 | $741.31 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $1,148.15 / $1,548.82
| Professional | | $407.38 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $323.59 / $467.74
| Facility | 26 | $70.79 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,778.28 / $4,677.35
| Professional | | $1,148.15 | $1,778.28 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $1,348.96
| Professional | 26 | $323.59 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $831.76 / $1,258.93 / $3,311.31
| Professional | TC | $831.76 | $1,258.93 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,584.89 / $2,238.72
| Professional | | $977.24 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $446.68 / $630.96
| Professional | 26 | $295.12 | $446.68 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $870.96 / $1,230.27 / $1,584.89
| Professional | TC | $870.96 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,148.15 / $1,905.46
| Professional | | $891.25 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $331.13 / $524.81
| Professional | 26 | $234.42 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $812.83 / $1,348.96
| Professional | TC | $630.96 | $812.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | 26 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,445.44 / $1,621.81
| Professional | | $1,148.15 | $1,445.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $467.74
| Professional | 26 | $323.59 | $407.38 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $831.76 / $1,023.29 / $1,148.15
| Professional | TC | $831.76 | $1,023.29 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,380.38 / $3,019.95
| Professional | | $891.25 | $1,380.38 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $398.11 / $851.14
| Professional | 26 | $281.84 | $398.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $2,137.96
| Professional | TC | $724.44 | $1,000.00 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $977.24
| Facility | 26 | $234.42 | $389.05 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,380.38 / $2,570.40
| Professional | | $831.76 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $389.05 / $724.44
| Professional | 26 | $234.42 | $389.05 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $977.24 / $1,862.09
| Professional | TC | $588.84 | $977.24 | $1,862.09 |