- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $575.44
| Facility | 26 | $338.84 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $630.96 / $2,754.23
| Professional | | $380.19 | $630.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $478.63 / $1,819.70
| Professional | 26 | $204.17 | $478.63 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $660.69
| Professional | TC | $186.21 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $707.95 / $2,630.27
| Professional | | $457.09 | $707.95 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $338.84 / $1,230.27
| Professional | 26 | $218.78 | $338.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $1,380.38
| Professional | TC | $245.47 | $380.19 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $309.03 / $602.56
| Professional | | $295.12 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $602.56 / $691.83 / $1,122.02
| Facility | 26 | $602.56 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,445.44 / $2,511.89
| Professional | | $660.69 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $602.56 / $1,174.90
| Professional | 26 | $263.03 | $602.56 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $851.14 / $1,318.26
| Professional | TC | $346.74 | $851.14 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,122.02 / $1,348.96
| Professional | | $977.24 | $1,122.02 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $524.81 / $645.65
| Professional | 26 | $457.09 | $524.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $602.56 / $724.44
| Professional | TC | $512.86 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,258.93 / $7,413.10
| Professional | | $562.34 | $1,258.93 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $512.86 / $1,698.24
| Professional | 26 | $263.03 | $512.86 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $676.08 / $6,165.95
| Professional | TC | $275.42 | $676.08 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $660.69
| Professional | | $32.36 | $33.11 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,202.26 / $2,187.76
| Professional | | $676.08 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $1,000.00
| Professional | 26 | $316.23 | $588.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $645.65 / $1,148.15
| Professional | TC | $354.81 | $645.65 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,380.38 / $3,235.94
| Professional | | $776.25 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $1,412.54 / $1,412.54
| Facility | 26 | $537.03 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $4,265.80 / $7,585.78
| Professional | | $851.14 | $4,265.80 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $1,122.02 / $1,698.24
| Professional | 26 | $371.54 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $3,548.13 / $6,456.54
| Professional | TC | $446.68 | $3,548.13 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Professional | 26 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | TC | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,951.21 / $3,630.78
| Professional | | $1,659.59 | $2,951.21 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $602.56 / $758.58 / $1,348.96
| Professional | 26 | $602.56 | $758.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $891.25 / $1,000.00 / $2,290.87
| Professional | TC | $891.25 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,089.30 / $3,548.13
| Professional | | $512.86 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $645.65 / $1,698.24
| Professional | 26 | $95.50 | $645.65 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $549.54 / $1,584.89
| Professional | TC | $263.03 | $549.54 | $1,584.89 |