- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $147.91 / $177.83
| Facility | 26 | $70.79 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $1,995.26
| Professional | | $199.53 | $363.08 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $131.83 / $501.19
| Professional | 26 | $61.66 | $131.83 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $407.38
| Professional | TC | $120.23 | $190.55 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $1,071.52
| Professional | | $186.21 | $302.00 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $100.00 / $371.54
| Professional | 26 | $64.57 | $100.00 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $213.80 / $707.95
| Professional | TC | $120.23 | $213.80 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $229.09
| Professional | | $83.18 | $144.54 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $199.53 / $316.23
| Facility | 26 | $169.82 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $512.86 / $776.25
| Professional | | $229.09 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $154.88 / $263.03
| Professional | 26 | $70.79 | $154.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $338.84 / $501.19
| Professional | TC | $158.49 | $338.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $416.87 / $562.34
| Professional | | $346.74 | $416.87 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $194.98
| Professional | 26 | $120.23 | $144.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $338.84
| Professional | TC | $223.87 | $269.15 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $1,258.93
| Facility | 26 | $616.60 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $467.74 / $1,698.24
| Professional | | $234.42 | $467.74 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $177.83 / $562.34
| Professional | 26 | $74.13 | $177.83 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $316.23 / $1,412.54
| Professional | TC | $154.88 | $316.23 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $302.00
| Professional | | $32.36 | $33.11 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $478.63 / $758.58
| Professional | | $234.42 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $245.47
| Professional | 26 | $91.20 | $154.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $363.08 / $549.54
| Professional | TC | $186.21 | $363.08 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $467.74 / $954.99
| Professional | | $245.47 | $467.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $602.56 / $602.56
| Facility | 26 | $151.36 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $977.24 / $1,698.24
| Professional | | $269.15 | $977.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $338.84 / $416.87
| Professional | 26 | $93.33 | $338.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $741.31 / $1,412.54
| Professional | TC | $173.78 | $741.31 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 26 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | TC | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,122.02 / $1,513.56
| Professional | | $758.58 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $245.47 / $371.54
| Professional | 26 | $229.09 | $245.47 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $575.44 / $776.25
| Professional | TC | $436.52 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $912.01 / $1,445.44
| Professional | | $95.50 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $309.03 / $501.19
| Professional | 26 | $87.10 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $398.11 / $954.99
| Professional | TC | $95.50 | $398.11 | $954.99 |