- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $281.84 / $446.68
| Facility | 26 | $112.20 | $281.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $1,412.54
| Professional | | $575.44 | $724.44 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $218.78 / $467.74
| Professional | 26 | $114.82 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $1,258.93
| Professional | 52 | $257.04 | $371.54 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $954.99
| Professional | TC | $457.09 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $707.95 / $2,951.21
| Professional | | $630.96 | $707.95 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $134.90 / $162.18
| Professional | 26 | $120.23 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $776.25
| Professional | TC | $588.84 | $588.84 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,023.29 / $1,995.26
| Professional | | $602.56 | $1,023.29 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $213.80 / $354.81
| Professional | 26 | $112.20 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $831.76 / $1,621.81
| Professional | TC | $478.63 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $1,548.82
| Professional | | $776.25 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $147.91 / $269.15
| Professional | 26 | $128.82 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $758.58 / $1,288.25
| Professional | TC | $660.69 | $758.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,047.13 / $1,949.84
| Professional | | $616.60 | $1,047.13 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $199.53 / $338.84
| Professional | 26 | $112.20 | $199.53 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $831.76 / $1,621.81
| Professional | TC | $512.86 | $831.76 | $1,621.81 |