- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $229.09
| Facility | 26 | $114.82 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,737.80
| Professional | | $549.54 | $758.58 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $549.54
| Professional | 26 | $112.20 | $208.93 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $275.42
| Professional | 52 | $173.78 | $257.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $562.34 / $1,737.80
| Professional | TC | $446.68 | $562.34 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $281.84 / $741.31
| Facility | 26 | $128.82 | $281.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,047.13 / $6,165.95
| Professional | | $549.54 | $1,047.13 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $204.17 / $2,570.40
| Professional | 26 | $112.20 | $204.17 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $912.01 / $7,079.46
| Professional | TC | $489.78 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,318.26 / $1,778.28
| Professional | | $776.25 | $1,318.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $302.00
| Professional | 26 | $131.83 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $389.05 / $645.65 / $891.25
| Professional | 52 | $389.05 | $645.65 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,047.13 / $1,819.70
| Professional | | $707.95 | $1,047.13 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $199.53 / $338.84
| Professional | 26 | $134.90 | $199.53 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $851.14 / $1,445.44
| Professional | TC | $575.44 | $851.14 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $457.09 / $1,096.48
| Professional | | $87.10 | $457.09 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,230.27 / $1,949.84
| Professional | | $691.83 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $331.13
| Professional | 26 | $123.03 | $213.80 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $977.24 / $1,513.56
| Professional | TC | $575.44 | $977.24 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $831.76 / $1,122.02
| Professional | | $181.97 | $831.76 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $281.84 / $741.31
| Facility | 26 | $128.82 | $281.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $1,047.13 / $6,165.95
| Professional | | $549.54 | $1,047.13 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $204.17 / $2,570.40
| Professional | 26 | $112.20 | $204.17 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $912.01 / $7,079.46
| Professional | TC | $489.78 | $912.01 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,148.15 / $2,041.74
| Professional | | $660.69 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $363.08
| Professional | 26 | $128.82 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $933.25 / $1,659.59
| Professional | TC | $549.54 | $933.25 | $1,659.59 |