- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $616.60 / $724.44
| Facility | 26 | $213.80 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,202.26 / $3,311.31
| Professional | | $724.44 | $1,202.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $630.96
| Professional | 26 | $109.65 | $194.98 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $154.88 / $1,071.52 / $2,344.23
| Professional | 52 | $154.88 | $1,071.52 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $676.08
| Professional | 53 | $398.11 | $549.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,778.28
| Professional | TC | $588.84 | $741.31 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,288.25 / $2,137.96
| Professional | | $724.44 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $199.53 / $436.52
| Professional | 26 | $97.72 | $199.53 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $1,047.13 / $1,698.24
| Professional | TC | $630.96 | $1,047.13 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,445.44 / $2,454.71
| Professional | | $870.96 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $251.19 / $363.08
| Professional | 26 | $131.83 | $251.19 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $1,174.90 / $2,137.96
| Professional | TC | $741.31 | $1,174.90 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,380.38 / $1,659.59
| Professional | | $1,148.15 | $1,380.38 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $288.40
| Professional | 26 | $162.18 | $199.53 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,000.00 / $1,096.48 / $1,412.54
| Professional | TC | $1,000.00 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $1,548.82 / $1,584.89
| Professional | | $229.09 | $1,548.82 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,174.90 / $2,398.83
| Professional | | $741.31 | $1,174.90 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $346.74
| Professional | 26 | $112.20 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $2,041.74
| Professional | TC | $630.96 | $954.99 | $2,041.74 |