- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $371.54
| Facility | 26 | $114.82 | $165.96 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $1,412.54
| Professional | | $549.54 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $181.97 / $512.86
| Professional | 26 | $112.20 | $181.97 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $173.78 / $275.42 / $1,202.26
| Professional | 52 | $173.78 | $275.42 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $575.44 / $1,148.15
| Professional | TC | $446.68 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $707.95 / $1,380.38
| Professional | | $416.87 | $707.95 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $141.25 / $309.03
| Professional | 26 | $79.43 | $141.25 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $1,122.02
| Professional | TC | $354.81 | $549.54 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $151.36 / $426.58
| Facility | 26 | $28.18 | $151.36 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $977.24 / $1,659.59
| Professional | | $602.56 | $977.24 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $316.23
| Professional | 26 | $120.23 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $776.25 / $1,348.96
| Professional | TC | $489.78 | $776.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $812.83 / $1,513.56
| Professional | | $512.86 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $316.23
| Professional | 26 | $104.71 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $676.08 / $1,318.26
| Professional | TC | $436.52 | $676.08 | $1,318.26 |