- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $1,122.02
| Facility | 26 | $154.88 | $245.47 | $1,122.02 |
- 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
- $109.65 / $177.83 / $446.68
| Professional | 26 | $109.65 | $177.83 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $588.84
| Professional | 52 | $128.82 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $1,096.48
| Professional | TC | $436.52 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $602.56 / $794.33
| Professional | | $549.54 | $602.56 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $134.90 / $162.18
| Professional | 26 | $112.20 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Professional | TC | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $1,819.70 / $1,819.70
| Professional | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $151.36 / $316.23
| Professional | 26 | $104.71 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $954.99 / $1,778.28
| Professional | | $489.78 | $954.99 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $181.97 / $316.23
| Professional | 26 | $89.13 | $181.97 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $776.25 / $1,412.54
| Professional | TC | $398.11 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $691.83 / $1,348.96
| Professional | | $602.56 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $234.42
| Professional | 26 | $117.49 | $181.97 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $870.96 / $1,148.15
| Professional | TC | $575.44 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $1,584.89
| Professional | | $512.86 | $645.65 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $288.40
| Professional | 26 | $95.50 | $120.23 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $537.03 / $1,288.25
| Professional | TC | $416.87 | $537.03 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $724.44 / $1,412.54
| Professional | | $478.63 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $275.42
| Professional | 26 | $87.10 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $1,202.26
| Professional | TC | $398.11 | $588.84 | $1,202.26 |