- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $204.17
| Facility | 26 | $144.54 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $1,513.56
| Professional | | $676.08 | $891.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $245.47
| Professional | 26 | $77.62 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $794.33 / $1,348.96
| Professional | TC | $588.84 | $794.33 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,258.93 / $4,677.35
| Professional | | $812.83 | $1,258.93 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $549.54
| Professional | 26 | $93.33 | $144.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,122.02 / $4,168.69
| Professional | TC | $724.44 | $1,122.02 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $251.19 / $295.12 / $467.74
| Facility | 26 | $251.19 | $295.12 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,951.21 / $3,311.31
| Professional | | $1,230.27 | $2,951.21 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $346.74 / $389.05
| Professional | 26 | $144.54 | $346.74 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,096.48 / $2,630.27 / $2,951.21
| Professional | TC | $1,096.48 | $2,630.27 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,862.09 / $2,238.72
| Professional | | $1,584.89 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $218.78 / $269.15
| Professional | 26 | $190.55 | $218.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $1,621.81 / $1,995.26
| Professional | TC | $1,412.54 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,819.70 / $5,623.41
| Professional | | $977.24 | $1,819.70 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $616.60
| Professional | 26 | $109.65 | $204.17 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $851.14 / $1,621.81 / $5,011.87
| Professional | TC | $851.14 | $1,621.81 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,380.38 / $2,398.83
| Professional | | $1,288.25 | $1,380.38 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $165.96 / $354.81
| Professional | 26 | $138.04 | $165.96 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,202.26 / $2,041.74
| Professional | TC | $1,148.15 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,862.09 / $2,754.23
| Professional | | $1,258.93 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $616.60 / $616.60
| Facility | 26 | $223.87 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $4,570.88 / $5,623.41
| Professional | | $1,288.25 | $4,570.88 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $501.19 / $616.60
| Professional | 26 | $158.49 | $501.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $4,073.80 / $5,011.87
| Professional | TC | $1,148.15 | $4,073.80 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,238.72 / $2,238.72 / $2,238.72
| Professional | | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | 26 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,995.26 / $1,995.26 / $1,995.26
| Professional | TC | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $5,128.61 / $6,918.31
| Professional | | $2,137.96 | $5,128.61 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $457.09
| Professional | 26 | $223.87 | $263.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,819.70 / $2,137.96 / $3,801.89
| Professional | TC | $1,819.70 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,737.80 / $3,801.89
| Professional | | $977.24 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $630.96
| Professional | 26 | $95.50 | $181.97 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $851.14 / $1,548.82 / $3,311.31
| Professional | TC | $851.14 | $1,548.82 | $3,311.31 |