- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $1,047.13
| Facility | 26 | $194.98 | $251.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $758.58 / $1,479.11
| Professional | | $549.54 | $758.58 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $562.34
| Professional | 26 | $112.20 | $208.93 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $549.54
| Professional | 52 | $218.78 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $1,348.96
| Professional | TC | $446.68 | $630.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $213.80 / $288.40
| Professional | 26 | $104.71 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | TC | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $912.01 / $1,258.93
| Professional | | $562.34 | $912.01 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $245.47
| Professional | 26 | $107.15 | $181.97 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $741.31 / $1,023.29
| Professional | TC | $446.68 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,318.26 / $1,621.81
| Professional | | $758.58 | $1,318.26 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $251.19 / $302.00
| Professional | 26 | $151.36 | $251.19 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $1,071.52 / $1,348.96
| Professional | TC | $602.56 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,230.27 / $6,165.95
| Professional | | $870.96 | $1,230.27 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $2,570.40
| Professional | 26 | $190.55 | $269.15 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $977.24 / $7,079.46
| Professional | TC | $724.44 | $977.24 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,288.25 / $1,513.56
| Professional | | $1,148.15 | $1,288.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $316.23
| Professional | 26 | $234.42 | $251.19 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $912.01 / $1,047.13 / $1,202.26
| Professional | TC | $912.01 | $1,047.13 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,380.38 / $1,513.56
| Professional | | $758.58 | $1,380.38 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $263.03 / $288.40
| Professional | 26 | $151.36 | $263.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $1,122.02 / $1,202.26
| Professional | TC | $602.56 | $1,122.02 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,174.90 / $1,479.11
| Professional | | $812.83 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $239.88 / $316.23
| Professional | 26 | $151.36 | $239.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $891.25 / $1,174.90
| Professional | TC | $645.65 | $891.25 | $1,174.90 |