- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $144.54 / $2,691.53
| Facility | 26 | $109.65 | $144.54 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $1,479.11
| Professional | | $549.54 | $724.44 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $436.52
| Professional | 26 | $112.20 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $128.82 / $380.19 / $1,148.15
| Professional | 52 | $128.82 | $380.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $1,202.26
| Professional | TC | $436.52 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $676.08 / $870.96
| Professional | | $204.17 | $676.08 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $128.82 / $151.36
| Professional | 26 | $114.82 | $128.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $616.60 / $707.95
| Professional | TC | $562.34 | $616.60 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $891.25 / $1,584.89
| Professional | | $602.56 | $891.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $302.00
| Professional | 26 | $107.15 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $741.31 / $1,288.25
| Professional | TC | $489.78 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,047.13
| Professional | | $537.03 | $776.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $186.21
| Professional | 26 | $93.33 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $660.69 / $870.96
| Professional | TC | $446.68 | $660.69 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $776.25 / $1,380.38
| Professional | | $537.03 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $269.15
| Professional | 26 | $102.33 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $630.96 / $1,148.15
| Professional | TC | $436.52 | $630.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $724.44 / $1,047.13
| Professional | | $630.96 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $123.03 / $181.97
| Professional | 26 | $112.20 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $588.84 / $870.96
| Professional | TC | $512.86 | $588.84 | $870.96 |