- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $288.40 / $724.44
| Facility | 26 | $199.53 | $288.40 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $562.34 / $1,862.09
| Professional | | $426.58 | $562.34 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $354.81 / $977.24
| Professional | 26 | $199.53 | $354.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $302.00 / $794.33
| Professional | TC | $229.09 | $302.00 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $562.34 / $1,148.15
| Professional | | $416.87 | $562.34 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $338.84 / $549.54
| Professional | 26 | $194.98 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | TC | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $1,445.44
| Professional | | $524.81 | $724.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $645.65
| Professional | 26 | $239.88 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $398.11 / $831.76
| Professional | TC | $281.84 | $398.11 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $724.44 / $1,659.59
| Professional | | $489.78 | $724.44 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $741.31
| Professional | 26 | $229.09 | $323.59 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $912.01
| Professional | TC | $269.15 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $630.96 / $1,288.25
| Professional | | $416.87 | $630.96 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $288.40 / $588.84
| Professional | 26 | $194.98 | $288.40 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $741.31
| Professional | TC | $234.42 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $831.76
| Professional | | $416.87 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $363.08
| Professional | 26 | $173.78 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $467.74
| Professional | TC | $239.88 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $602.56 / $1,148.15
| Professional | | $457.09 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $537.03
| Professional | 26 | $229.09 | $316.23 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $660.69
| Professional | TC | $275.42 | $389.05 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | 26 | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $3,981.07 / $3,981.07
| Professional | | $2,884.03 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,412.54 / $1,862.09 / $1,862.09
| Professional | 26 | $1,412.54 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $2,137.96 / $2,137.96
| Professional | TC | $1,479.11 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $223.87 / $524.81
| Professional | | $32.36 | $223.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | 26 | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $1,258.93
| Professional | | $416.87 | $616.60 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $281.84 / $588.84
| Professional | 26 | $194.98 | $281.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $741.31
| Professional | TC | $234.42 | $346.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | 26 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $870.96
| Professional | TC | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $562.34 / $707.95
| Professional | | $416.87 | $562.34 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $616.60 / $1,348.96
| Professional | | $380.19 | $616.60 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $602.56
| Professional | 26 | $177.83 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $331.13 / $758.58
| Professional | TC | $199.53 | $331.13 | $758.58 |