- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $257.04 / $3,890.45
| Facility | 26 | $223.87 | $257.04 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $776.25 / $1,819.70
| Professional | | $549.54 | $776.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $257.04 / $1,148.15
| Professional | 26 | $114.82 | $257.04 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $5,495.41
| Professional | 52 | $199.53 | $199.53 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $1,230.27
| Professional | TC | $416.87 | $588.84 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $977.24 / $2,238.72
| Professional | | $630.96 | $977.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $190.55 / $436.52
| Professional | 26 | $125.89 | $190.55 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $794.33 / $1,778.28
| Professional | TC | $501.19 | $794.33 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $588.84 / $1,071.52
| Professional | | $144.54 | $588.84 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $371.54 / $602.56
| Facility | 26 | $323.59 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,698.24 / $3,162.28
| Professional | | $891.25 | $1,698.24 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $309.03 / $588.84
| Professional | 26 | $169.82 | $309.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $1,412.54 / $2,570.40
| Professional | TC | $707.95 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,380.38 / $1,819.70
| Professional | | $1,174.90 | $1,380.38 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $251.19 / $338.84
| Professional | 26 | $218.78 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $954.99 / $1,122.02 / $1,513.56
| Professional | TC | $954.99 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,380.38 / $6,165.95
| Professional | | $741.31 | $1,380.38 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $295.12 / $1,071.52
| Professional | 26 | $144.54 | $295.12 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $1,096.48 / $3,890.45
| Professional | TC | $602.56 | $1,096.48 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $380.19
| Professional | | $32.36 | $33.11 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $1,000.00 / $1,659.59
| Professional | | $489.78 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $316.23
| Professional | 26 | $125.89 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $891.25 / $1,348.96
| Professional | TC | $549.54 | $891.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,584.89 / $2,344.23
| Professional | | $912.01 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $776.25 / $776.25
| Facility | 26 | $281.84 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $3,235.94 / $6,165.95
| Professional | | $831.76 | $3,235.94 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $724.44 / $1,071.52
| Professional | 26 | $158.49 | $724.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $2,511.89 / $3,981.07
| Professional | TC | $676.08 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | 26 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $630.96
| Professional | TC | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $2,454.71 / $4,073.80
| Professional | | $977.24 | $2,454.71 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $398.11 / $954.99
| Professional | 26 | $302.00 | $398.11 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $1,288.25 / $3,890.45
| Professional | TC | $489.78 | $1,288.25 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,995.26 / $2,951.21
| Professional | | $741.31 | $1,995.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $363.08 / $588.84
| Professional | 26 | $120.23 | $363.08 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $977.24 / $1,949.84
| Professional | TC | $602.56 | $977.24 | $1,949.84 |