- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $190.55 / $331.13
| Facility | 26 | $112.20 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $1,288.25
| Professional | | $575.44 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $389.05
| Professional | 26 | $114.82 | $154.88 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $512.86
| Professional | 52 | $257.04 | $257.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $549.54 / $1,023.29
| Professional | TC | $457.09 | $549.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $870.96 / $1,621.81
| Professional | | $630.96 | $870.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $295.12
| Professional | 26 | $120.23 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $707.95 / $1,318.26
| Professional | TC | $501.19 | $707.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $794.33 / $2,570.40
| Professional | | $194.98 | $794.33 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $134.90 / $186.21
| Professional | 26 | $120.23 | $134.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $645.65 / $1,000.00
| Professional | TC | $588.84 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | 26 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $977.24 / $1,412.54
| Professional | | $645.65 | $977.24 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $309.03
| Professional | 26 | $120.23 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $1,148.15
| Professional | TC | $524.81 | $776.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $831.76 / $1,047.13
| Professional | | $660.69 | $831.76 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $190.55
| Professional | 26 | $107.15 | $134.90 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $954.99
| Professional | TC | $549.54 | $691.83 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,174.90 / $1,288.25
| Professional | | $933.25 | $1,174.90 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $295.12
| Professional | 26 | $234.42 | $288.40 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $812.83 / $2,570.40
| Professional | | $165.96 | $812.83 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $181.97 / $275.42
| Professional | 26 | $123.03 | $181.97 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $741.31 / $1,096.48
| Professional | TC | $524.81 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $912.01 / $1,445.44
| Professional | | $575.44 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $281.84
| Professional | 26 | $107.15 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,174.90
| Professional | TC | $478.63 | $741.31 | $1,174.90 |