- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $141.25 / $151.36
| Facility | 26 | $112.20 | $141.25 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $776.25 / $1,698.24
| Professional | | $575.44 | $776.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $380.19
| Professional | 26 | $114.82 | $165.96 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $1,230.27
| Professional | 52 | $190.55 | $257.04 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $1,122.02
| Professional | TC | $457.09 | $588.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $707.95 / $891.25
| Professional | | $269.15 | $707.95 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $134.90 / $154.88
| Professional | 26 | $120.23 | $134.90 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $741.31
| Professional | TC | $588.84 | $588.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $1,737.80
| Professional | | $630.96 | $933.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $177.83 / $309.03
| Professional | 26 | $112.20 | $177.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $1,412.54
| Professional | TC | $512.86 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $831.76 / $1,096.48
| Professional | | $562.34 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $138.04 / $194.98
| Professional | 26 | $95.50 | $138.04 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $912.01
| Professional | TC | $467.74 | $691.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $851.14 / $1,479.11
| Professional | | $562.34 | $851.14 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $281.84
| Professional | 26 | $107.15 | $162.18 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $691.83 / $1,174.90
| Professional | TC | $457.09 | $691.83 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $758.58 / $1,122.02
| Professional | | $691.83 | $758.58 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $128.82 / $186.21
| Professional | 26 | $123.03 | $128.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $630.96 / $933.25
| Professional | TC | $562.34 | $630.96 | $933.25 |