- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $213.80
| Facility | 26 | $109.65 | $190.55 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $436.52 / $912.01
| Professional | | $363.08 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $346.74
| Professional | 26 | $79.43 | $112.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $758.58
| Professional | TC | $281.84 | $346.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $95.50 / $134.90
| Facility | 26 | $20.42 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $812.83 / $1,230.27
| Professional | | $467.74 | $812.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $229.09
| Professional | 26 | $95.50 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $660.69 / $1,023.29
| Professional | TC | $371.54 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,096.48 / $1,230.27
| Professional | | $912.01 | $1,096.48 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $190.55 / $223.87
| Professional | 26 | $169.82 | $190.55 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,000.00
| Professional | TC | $724.44 | $912.01 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $213.80
| Facility | 26 | $109.65 | $190.55 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $870.96 / $1,174.90
| Professional | | $436.52 | $870.96 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $251.19
| Professional | 26 | $97.72 | $177.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $724.44 / $1,000.00
| Professional | TC | $302.00 | $724.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $741.31
| Professional | | $125.89 | $239.88 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $891.25 / $1,230.27
| Professional | | $549.54 | $891.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $229.09
| Professional | 26 | $109.65 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $660.69 / $1,023.29
| Professional | TC | $380.19 | $660.69 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | 26 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $912.01 / $1,258.93
| Professional | | $691.83 | $912.01 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $239.88
| Professional | 26 | $141.25 | $177.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $758.58 / $1,023.29
| Professional | TC | $537.03 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $794.33 / $1,174.90
| Professional | | $363.08 | $794.33 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $239.88
| Professional | 26 | $89.13 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $630.96 / $933.25
| Professional | TC | $263.03 | $630.96 | $933.25 |