- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $177.83 / $269.15
| Facility | 26 | $102.33 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $501.19 / $1,513.56
| Professional | | $144.54 | $501.19 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $141.25 / $380.19
| Professional | 26 | $64.57 | $141.25 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $1,230.27 / $1,905.46
| Professional | 50 | $660.69 | $1,230.27 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $151.36 / $1,047.13 / $1,047.13
| Professional | 52 | $151.36 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $338.84 / $891.25
| Professional | TC | $154.88 | $338.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $407.38
| Professional | | $158.49 | $199.53 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $104.71 / $151.36
| Professional | 26 | $51.29 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $109.65 / $323.59
| Professional | TC | $107.15 | $109.65 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $616.60 / $954.99
| Professional | | $363.08 | $616.60 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $93.33 / $190.55
| Professional | 26 | $64.57 | $93.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $309.03 / $380.19 / $870.96
| Professional | 50 | $309.03 | $380.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $512.86 / $794.33
| Professional | TC | $257.04 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $407.38 / $776.25
| Professional | | $275.42 | $407.38 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $208.93
| Professional | 26 | $77.62 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $549.54
| Professional | TC | $199.53 | $295.12 | $549.54 |
- 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
- $190.55 / $398.11 / $794.33
| Professional | | $190.55 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $162.18
| Professional | 26 | $44.67 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $309.03 / $676.08
| Professional | TC | $138.04 | $309.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $371.54
| Professional | | $199.53 | $275.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $97.72
| Professional | 26 | $53.70 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $199.53 / $269.15
| Professional | TC | $144.54 | $199.53 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $524.81
| Professional | | $204.17 | $275.42 | $524.81 |
- 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
- $165.96 / $229.09 / $389.05
| Professional | TC | $165.96 | $229.09 | $389.05 |
- 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
- $416.87 / $2,884.03 / $2,884.03
| Professional | | $416.87 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Professional | 26 | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Professional | TC | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $77.62 / $239.88
| Professional | | $32.36 | $77.62 | $239.88 |
- 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
- $194.98 / $407.38 / $758.58
| Professional | | $194.98 | $407.38 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $77.62 / $144.54
| Professional | 26 | $39.81 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $302.00 / $660.69
| Professional | TC | $128.82 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Professional | 26 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Professional | TC | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $309.03 / $954.99
| Professional | | $223.87 | $309.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $831.76
| Professional | | $199.53 | $331.13 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $223.87
| Professional | 26 | $52.48 | $74.13 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $234.42 / $660.69
| Professional | TC | $138.04 | $234.42 | $660.69 |