- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $199.53
| Facility | 26 | $177.83 | $177.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $831.76
| Professional | | $346.74 | $478.63 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $229.09
| Professional | 26 | $85.11 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $616.60
| Professional | TC | $257.04 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $562.34 / $1,995.26
| Professional | | $338.84 | $562.34 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $478.63
| Professional | 26 | $83.18 | $131.83 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $501.19 / $891.25 / $2,951.21
| Professional | 50 | $501.19 | $891.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $457.09 / $1,513.56
| Professional | TC | $257.04 | $457.09 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $416.87
| Facility | 26 | $223.87 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $933.25 / $1,412.54
| Professional | | $389.05 | $933.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $239.88 / $346.74
| Professional | 26 | $93.33 | $239.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $707.95 / $1,071.52
| Professional | TC | $302.00 | $707.95 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $758.58 / $1,023.29
| Professional | | $630.96 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $186.21 / $251.19
| Professional | 26 | $154.88 | $186.21 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $954.99 / $1,122.02 / $1,548.82
| Professional | 50 | $954.99 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $562.34 / $794.33
| Professional | TC | $478.63 | $562.34 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $851.14 / $3,019.95
| Professional | | $446.68 | $851.14 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $177.83 / $851.14
| Professional | 26 | $91.20 | $177.83 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $2,570.40
| Professional | TC | $338.84 | $660.69 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $575.44
| Professional | | $32.36 | $33.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $831.76 / $1,288.25
| Professional | | $426.58 | $831.76 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $338.84
| Professional | 26 | $117.49 | $199.53 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $691.83 / $1,047.13
| Professional | TC | $389.05 | $691.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $851.14 / $1,513.56
| Professional | | $446.68 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $776.25 / $776.25
| Facility | 26 | $199.53 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,862.09 / $3,019.95
| Professional | | $489.78 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $446.68 / $851.14
| Professional | 26 | $123.03 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $1,548.82 / $2,630.27
| Professional | TC | $371.54 | $1,548.82 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $912.01 / $912.01
| Professional | | $912.01 | $912.01 | $912.01 |
- 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
- $691.83 / $691.83 / $691.83
| Professional | TC | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $2,137.96 / $2,951.21
| Professional | | $1,778.28 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $602.56
| Professional | 26 | $331.13 | $501.19 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,318.26 / $1,819.70 / $2,187.76
| Professional | TC | $1,318.26 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $741.31 / $2,691.53
| Professional | | $85.11 | $741.31 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $398.11 / $645.65
| Professional | 26 | $87.10 | $398.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $537.03 / $1,071.52
| Professional | TC | $302.00 | $537.03 | $1,071.52 |