- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $154.88 / $165.96
| Facility | 26 | $147.91 | $154.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $467.74 / $1,174.90
| Professional | | $338.84 | $467.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $575.44
| Professional | 26 | $162.18 | $245.47 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $229.09 / $446.68
| Professional | TC | $162.18 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $794.33
| Professional | | $354.81 | $537.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $223.87 / $309.03
| Professional | 26 | $181.97 | $223.87 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $371.54 / $575.44
| Professional | | $177.83 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $758.58
| Professional | | $457.09 | $549.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $229.09
| Professional | 26 | $213.80 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $933.25
| Professional | | $407.38 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $263.03 / $446.68
| Professional | 26 | $190.55 | $263.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $524.81
| Professional | TC | $208.93 | $316.23 | $524.81 |
- 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
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $165.96 / $302.00
| Facility | 26 | $151.36 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $616.60 / $1,122.02
| Professional | | $338.84 | $616.60 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $316.23 / $549.54
| Professional | 26 | $162.18 | $316.23 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $338.84 / $588.84
| Professional | TC | $173.78 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $389.05
| Professional | | $32.36 | $33.11 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $851.14 / $977.24
| Professional | | $707.95 | $851.14 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $537.03 / $912.01
| Professional | | $407.38 | $537.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $426.58
| Professional | 26 | $190.55 | $257.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $524.81
| Professional | TC | $208.93 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $616.60 / $794.33
| Professional | | $426.58 | $616.60 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $363.08
| Professional | 26 | $190.55 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $331.13 / $436.52
| Professional | TC | $234.42 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $478.63 / $478.63
| Professional | | $457.09 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $229.09 / $229.09
| Professional | 26 | $218.78 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | TC | $251.19 | $251.19 | $251.19 |