- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $173.78
| Facility | 26 | $75.86 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $426.58 / $1,230.27
| Professional | | $134.90 | $426.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $128.82 / $363.08
| Professional | 26 | $64.57 | $128.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $83.18 / $281.84 / $2,137.96
| Professional | 50 | $83.18 | $281.84 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $616.60
| Professional | TC | $181.97 | $316.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $162.18 / $190.55
| Professional | | $154.88 | $162.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $50.12 / $57.54
| Professional | 26 | $36.31 | $50.12 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $870.96
| Professional | | $229.09 | $288.40 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $72.44 / $138.04
| Professional | 26 | $58.88 | $72.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $346.74 / $426.58 / $1,148.15
| Professional | 50 | $346.74 | $426.58 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $602.56
| Professional | TC | $169.82 | $213.80 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $263.03 / $354.81
| Professional | | $93.33 | $263.03 | $354.81 |
- 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
- $229.09 / $524.81 / $1,949.84
| Professional | | $229.09 | $524.81 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $234.42
| Professional | 26 | $48.98 | $104.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $398.11 / $1,548.82
| Professional | TC | $162.18 | $398.11 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $501.19
| Professional | | $234.42 | $316.23 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $323.59
| Professional | 26 | $63.10 | $87.10 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $234.42 / $354.81
| Professional | TC | $173.78 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $575.44
| Professional | | $208.93 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $102.33 / $147.91
| Professional | 26 | $52.48 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $380.19
| Professional | TC | $151.36 | $275.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $562.34
| Professional | | $309.03 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $138.04
| Professional | 26 | $81.28 | $81.28 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | 50 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $724.44 / $776.25
| Professional | | $316.23 | $724.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $208.93
| Professional | 26 | $83.18 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $512.86
| Professional | TC | $234.42 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $1,513.56
| Professional | | $208.93 | $338.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $407.38
| Professional | 26 | $56.23 | $85.11 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $251.19 / $1,148.15
| Professional | TC | $162.18 | $251.19 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $208.93
| Facility | 26 | $52.48 | $74.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $363.08 / $660.69
| Professional | | $208.93 | $363.08 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $162.18
| Professional | 26 | $52.48 | $93.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $275.42 / $478.63
| Professional | TC | $147.91 | $275.42 | $478.63 |