- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $229.09 / $562.34
| Facility | 26 | $131.83 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,621.81
| Professional | | $575.44 | $758.58 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $371.54
| Professional | 26 | $112.20 | $151.36 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $213.80 / $213.80 / $213.80
| Professional | 52 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $1,202.26
| Professional | TC | $457.09 | $588.84 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $165.96
| Professional | 26 | $128.82 | $128.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,023.29 / $1,445.44
| Professional | | $707.95 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $269.15
| Professional | 26 | $123.03 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $831.76 / $1,174.90
| Professional | TC | $588.84 | $831.76 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,096.48 / $2,041.74
| Professional | | $776.25 | $1,096.48 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $213.80 / $407.38
| Professional | 26 | $138.04 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,621.81
| Professional | TC | $630.96 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,174.90 / $1,862.09
| Professional | | $776.25 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $323.59
| Professional | 26 | $134.90 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $954.99 / $1,513.56
| Professional | TC | $645.65 | $954.99 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,258.93 / $2,187.76
| Professional | | $776.25 | $1,258.93 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $223.87 / $354.81
| Professional | 26 | $134.90 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $1,023.29 / $1,659.59
| Professional | TC | $645.65 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $165.96
| Facility | 26 | $75.86 | $89.13 | $165.96 |