- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $263.03 / $954.99
| Facility | 26 | $204.17 | $263.03 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $2,137.96
| Professional | | $588.84 | $812.83 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $213.80 / $562.34
| Professional | 26 | $117.49 | $213.80 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | 52 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $691.83 / $1,230.27
| Professional | TC | $467.74 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $295.12
| Professional | 26 | $109.65 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $537.03
| Professional | TC | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $954.99 / $1,318.26
| Professional | | $588.84 | $954.99 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $257.04
| Professional | 26 | $112.20 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $776.25 / $1,071.52
| Professional | TC | $467.74 | $776.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,380.38 / $1,698.24
| Professional | | $794.33 | $1,380.38 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $309.03
| Professional | 26 | $158.49 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $1,122.02 / $1,412.54
| Professional | TC | $630.96 | $1,122.02 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | 26 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,288.25 / $6,165.95
| Professional | | $912.01 | $1,288.25 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $1,071.52
| Professional | 26 | $199.53 | $281.84 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $1,047.13 / $3,890.45
| Professional | TC | $758.58 | $1,047.13 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,348.96 / $1,584.89
| Professional | | $1,230.27 | $1,348.96 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $331.13
| Professional | 26 | $245.47 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $977.24 / $1,096.48 / $1,288.25
| Professional | TC | $977.24 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,445.44 / $1,584.89
| Professional | | $794.33 | $1,445.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $275.42 / $302.00
| Professional | 26 | $158.49 | $275.42 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $1,174.90 / $1,258.93
| Professional | TC | $630.96 | $1,174.90 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,230.27 / $1,548.82
| Professional | | $851.14 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $331.13
| Professional | 26 | $158.49 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $977.24 / $1,230.27
| Professional | TC | $676.08 | $977.24 | $1,230.27 |