- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $380.19
| Facility | 26 | $141.25 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $524.81 / $1,949.84
| Professional | | $190.55 | $524.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $141.25 / $371.54
| Professional | 26 | $69.18 | $141.25 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $812.83
| Professional | TC | $263.03 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $331.13 / $707.95
| Professional | | $223.87 | $331.13 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $128.82 / $151.36
| Professional | 26 | $48.98 | $128.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $549.54
| Professional | TC | $186.21 | $186.21 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $645.65 / $1,148.15
| Professional | | $389.05 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $186.21
| Professional | 26 | $58.88 | $81.28 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $562.34 / $954.99
| Professional | TC | $323.59 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $1,122.02
| Professional | | $398.11 | $588.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $199.53
| Professional | 26 | $77.62 | $109.65 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $478.63 / $933.25
| Professional | TC | $323.59 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $72.44 / $104.71
| Facility | 26 | $15.49 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $512.86 / $977.24
| Professional | | $275.42 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $158.49
| Professional | 26 | $44.67 | $81.28 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $426.58 / $831.76
| Professional | TC | $234.42 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $407.38 / $549.54
| Professional | | $302.00 | $407.38 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $97.72
| Professional | 26 | $54.95 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $338.84 / $457.09
| Professional | TC | $251.19 | $338.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $691.83
| Professional | | $295.12 | $389.05 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $162.18
| Professional | 26 | $64.57 | $87.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $645.65
| Professional | TC | $281.84 | $380.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 26 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $3,019.95
| Professional | | $2,884.03 | $2,884.03 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $467.74 / $512.86 / $512.86
| Professional | 26 | $467.74 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,570.40
| Professional | TC | $2,511.89 | $2,511.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $75.86 / $354.81
| Professional | | $32.36 | $75.86 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | 26 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $549.54 / $912.01
| Professional | | $275.42 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $75.86 / $144.54
| Professional | 26 | $38.90 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $758.58
| Professional | TC | $208.93 | $389.05 | $758.58 |
- 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
- $218.78 / $218.78 / $218.78
| Professional | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Professional | TC | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $512.86
| Professional | | $302.00 | $398.11 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $1,023.29
| Professional | | $302.00 | $416.87 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $213.80
| Professional | 26 | $51.29 | $72.44 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $758.58
| Professional | TC | $245.47 | $346.74 | $758.58 |