- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 26 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $954.99
| Professional | | $316.23 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $257.04
| Professional | 26 | $95.50 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $436.52
| Professional | 52 | $426.58 | $426.58 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $269.15 / $602.56
| Professional | TC | $218.78 | $269.15 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $457.09 / $1,071.52
| Professional | | $323.59 | $457.09 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $134.90 / $371.54
| Professional | 26 | $117.49 | $134.90 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $288.40 / $707.95
| Professional | TC | $204.17 | $288.40 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $323.59
| Facility | 26 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $1,000.00 / $2,290.87
| Professional | | $457.09 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $316.23 / $758.58
| Professional | 26 | $134.90 | $316.23 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $436.52
| Professional | 52 | $426.58 | $426.58 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $691.83 / $1,513.56
| Professional | TC | $309.03 | $691.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,995.26
| Professional | | $1,479.11 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $645.65
| Professional | 26 | $407.38 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $954.99 / $1,071.52 / $1,348.96
| Professional | TC | $954.99 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $812.83 / $812.83
| Professional | | $316.23 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $371.54
| Professional | 26 | $100.00 | $144.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $707.95
| Professional | TC | $208.93 | $309.03 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $851.14 / $1,819.70
| Professional | | $363.08 | $851.14 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $295.12 / $676.08
| Professional | 26 | $109.65 | $295.12 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $562.34 / $1,122.02
| Professional | TC | $251.19 | $562.34 | $1,122.02 |