- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $467.74 / $1,479.11
| Professional | | $331.13 | $467.74 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $524.81
| Professional | 26 | $97.72 | $138.04 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $436.52
| Professional | 52 | $151.36 | $302.00 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $275.42 / $602.56
| Professional | TC | $199.53 | $275.42 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $251.19 / $630.96
| Facility | 26 | $223.87 | $251.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $1,348.96
| Professional | | $288.40 | $512.86 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $398.11
| Professional | 26 | $77.62 | $154.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $371.54 / $954.99
| Professional | TC | $213.80 | $371.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,348.96 / $1,348.96
| Professional | | $588.84 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $309.03 / $371.54
| Professional | 26 | $100.00 | $309.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $645.65 / $1,230.27
| Professional | | $389.05 | $645.65 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $354.81
| Professional | 26 | $120.23 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $457.09 / $870.96
| Professional | TC | $263.03 | $457.09 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $208.93 / $489.78
| Professional | | $74.13 | $208.93 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $616.60 / $1,023.29
| Professional | | $346.74 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $186.21 / $275.42
| Professional | 26 | $107.15 | $186.21 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $407.38 / $616.60
| Professional | TC | $239.88 | $407.38 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $181.97 / $660.69
| Professional | | $173.78 | $181.97 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $251.19 / $630.96
| Facility | 26 | $223.87 | $251.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $1,348.96
| Professional | | $288.40 | $512.86 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $398.11
| Professional | 26 | $77.62 | $154.88 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $371.54 / $954.99
| Professional | TC | $213.80 | $371.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $1,288.25
| Professional | | $371.54 | $549.54 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $316.23
| Professional | 26 | $114.82 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $758.58
| Professional | TC | $245.47 | $389.05 | $758.58 |