- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $158.49 / $371.54
| Facility | 26 | $64.57 | $158.49 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $407.38 / $1,548.82
| Professional | | $213.80 | $407.38 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $251.19
| Professional | 26 | $57.54 | $85.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $295.12 / $724.44
| Professional | TC | $151.36 | $295.12 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $134.90
| Professional | 26 | $97.72 | $97.72 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $933.25
| Professional | | $354.81 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $181.97
| Professional | 26 | $69.18 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $741.31
| Professional | TC | $275.42 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $933.25
| Professional | | $354.81 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $117.49 / $213.80
| Professional | 26 | $83.18 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $707.95
| Professional | TC | $275.42 | $398.11 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $97.72
| Facility | 26 | $14.45 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $380.19 / $724.44
| Professional | | $208.93 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $83.18 / $158.49
| Professional | 26 | $42.66 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $295.12 / $562.34
| Professional | TC | $154.88 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $380.19
| Professional | | $204.17 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $89.13
| Professional | 26 | $47.86 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $288.40
| Professional | TC | $158.49 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $537.03
| Professional | | $204.17 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $77.62 / $125.89
| Professional | 26 | $57.54 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $398.11
| Professional | TC | $173.78 | $223.87 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $380.19 / $380.19
| Facility | 26 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $2,344.23
| Professional | | $1,995.26 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $588.84
| Professional | 26 | $489.78 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,949.84
| Professional | TC | $1,621.81 | $1,621.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $70.79 / $281.84
| Professional | | $32.36 | $70.79 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Facility | 26 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $407.38 / $645.65
| Professional | | $208.93 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $77.62 / $138.04
| Professional | 26 | $41.69 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $281.84 / $537.03
| Professional | TC | $151.36 | $281.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Professional | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $204.17
| Professional | 26 | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | TC | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $562.34
| Professional | | $229.09 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $309.03 / $660.69
| Professional | | $213.80 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $204.17
| Professional | 26 | $52.48 | $70.79 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $524.81
| Professional | TC | $158.49 | $251.19 | $524.81 |