- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $338.84
| Facility | 26 | $147.91 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $1,698.24
| Professional | | $588.84 | $812.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $616.60
| Professional | 26 | $114.82 | $173.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $295.12 / $1,258.93 / $1,258.93
| Professional | 52 | $295.12 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $660.69 / $1,348.96
| Professional | TC | $467.74 | $660.69 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $707.95 / $1,621.81
| Professional | | $602.56 | $707.95 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $223.87 / $257.04
| Professional | 26 | $109.65 | $223.87 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | TC | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 26 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $691.83 / $1,621.81
| Professional | | $630.96 | $691.83 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $125.89 / $309.03
| Professional | 26 | $120.23 | $125.89 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $537.03 / $1,348.96
| Professional | TC | $489.78 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $1,174.90 / $1,995.26
| Professional | | $630.96 | $1,174.90 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $363.08
| Professional | 26 | $123.03 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $954.99 / $1,659.59
| Professional | TC | $501.19 | $954.99 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $186.21 / $309.03
| Facility | 26 | $117.49 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,584.89
| Professional | | $588.84 | $912.01 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $177.83 / $281.84
| Professional | 26 | $109.65 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,288.25
| Professional | TC | $478.63 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $1,047.13
| Professional | | $131.83 | $239.88 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $165.96
| Facility | 26 | $162.18 | $162.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,230.27 / $1,778.28
| Professional | | $891.25 | $1,230.27 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $234.42 / $338.84
| Professional | 26 | $165.96 | $234.42 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,412.54
| Professional | TC | $724.44 | $1,023.29 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 26 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $691.83 / $1,513.56
| Professional | | $630.96 | $691.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $125.89 / $302.00
| Professional | 26 | $120.23 | $125.89 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $537.03 / $1,230.27
| Professional | TC | $501.19 | $537.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,148.15 / $1,778.28
| Professional | | $707.95 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $229.09 / $346.74
| Professional | 26 | $128.82 | $229.09 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $912.01 / $1,380.38
| Professional | TC | $588.84 | $912.01 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $851.14 / $1,621.81
| Professional | | $741.31 | $851.14 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $134.90 / $257.04
| Professional | 26 | $125.89 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $707.95 / $1,348.96
| Professional | TC | $616.60 | $707.95 | $1,348.96 |