- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $436.52 / $512.86
| Facility | 26 | $186.21 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $549.54 / $2,398.83
| Professional | | $323.59 | $549.54 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $398.11
| Professional | 26 | $100.00 | $162.18 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $165.96 / $239.88 / $239.88
| Professional | 52 | $165.96 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $302.00 / $891.25
| Professional | TC | $204.17 | $302.00 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $912.01 / $1,621.81
| Professional | | $346.74 | $912.01 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $213.80 / $295.12
| Professional | 26 | $107.15 | $213.80 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $575.44 / $1,348.96
| Professional | TC | $234.42 | $575.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $1,047.13 / $1,513.56
| Professional | | $436.52 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $162.18 / $316.23
| Professional | 26 | $120.23 | $162.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $741.31 / $1,318.26
| Professional | TC | $302.00 | $741.31 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,047.13 / $1,584.89
| Professional | | $457.09 | $1,047.13 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $173.78
| Professional | 26 | $120.23 | $144.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $831.76
| Professional | TC | $257.04 | $363.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $213.80 / $954.99
| Professional | | $158.49 | $213.80 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $1,819.70
| Professional | | $316.23 | $489.78 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $389.05
| Professional | 26 | $97.72 | $138.04 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $331.13 / $1,318.26
| Professional | TC | $213.80 | $331.13 | $1,318.26 |