- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $97.72
| Facility | 26 | $56.23 | $79.43 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $309.03 / $1,202.26
| Professional | | $199.53 | $309.03 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $74.13 / $181.97
| Professional | 26 | $33.11 | $74.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $645.65
| Professional | TC | $177.83 | $275.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $407.38 / $1,479.11
| Professional | | $257.04 | $407.38 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $204.17
| Professional | 26 | $36.31 | $57.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $346.74 / $1,258.93
| Professional | TC | $223.87 | $346.74 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $275.42 / $323.59
| Professional | | $48.98 | $275.42 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $117.49 / $186.21
| Facility | 26 | $100.00 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $660.69 / $1,412.54
| Professional | | $302.00 | $660.69 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $100.00 / $194.98
| Professional | 26 | $43.65 | $100.00 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $562.34 / $1,202.26
| Professional | TC | $251.19 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $758.58
| Professional | | $537.03 | $630.96 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $104.71
| Professional | 26 | $75.86 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $537.03 / $645.65
| Professional | TC | $457.09 | $537.03 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $537.03 / $2,398.83
| Professional | | $251.19 | $537.03 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $85.11 / $724.44
| Professional | 26 | $40.74 | $85.11 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $457.09 / $1,659.59
| Professional | TC | $223.87 | $457.09 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $251.19
| Professional | | $32.36 | $33.11 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $489.78 / $1,230.27
| Professional | | $389.05 | $489.78 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $165.96
| Professional | 26 | $52.48 | $91.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $398.11 / $1,047.13
| Professional | TC | $338.84 | $398.11 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $645.65 / $1,202.26
| Professional | | $436.52 | $645.65 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $467.74 / $467.74
| Facility | 26 | $100.00 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,348.96 / $2,398.83
| Professional | | $436.52 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $186.21 / $724.44
| Professional | 26 | $61.66 | $186.21 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $1,148.15 / $1,659.59
| Professional | TC | $371.54 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | TC | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,659.59 / $2,137.96
| Professional | | $891.25 | $1,659.59 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $123.03 / $208.93
| Professional | 26 | $117.49 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $794.33 / $1,122.02
| Professional | TC | $275.42 | $794.33 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $724.44 / $1,995.26
| Professional | | $95.50 | $724.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $104.71 / $239.88
| Professional | 26 | $44.67 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $416.87 / $1,023.29
| Professional | TC | $181.97 | $416.87 | $1,023.29 |