- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $181.97 / $229.09
| Facility | 26 | $114.82 | $181.97 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $676.08 / $1,230.27
| Professional | | $575.44 | $676.08 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $288.40
| Professional | 26 | $114.82 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $204.17 / $549.54 / $1,258.93
| Professional | 52 | $204.17 | $549.54 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $537.03 / $851.14
| Professional | TC | $436.52 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $162.18
| Professional | 26 | $109.65 | $141.25 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $588.84 / $812.83
| Professional | | $123.03 | $588.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $851.14 / $1,122.02
| Professional | | $645.65 | $851.14 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $263.03
| Professional | 26 | $131.83 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $691.83 / $851.14
| Professional | TC | $501.19 | $691.83 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $758.58 / $758.58
| Facility | 26 | $288.40 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $831.76 / $6,165.95
| Professional | | $549.54 | $831.76 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $1,071.52
| Professional | 26 | $107.15 | $181.97 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $676.08 / $3,890.45
| Professional | TC | $426.58 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,202.26
| Professional | | $524.81 | $691.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $234.42
| Professional | 26 | $102.33 | $134.90 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $933.25
| Professional | TC | $416.87 | $549.54 | $933.25 |