- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $194.98 / $194.98
| Facility | 26 | $186.21 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $977.24
| Professional | | $331.13 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $346.74
| Professional | 26 | $95.50 | $134.90 | $346.74 |
- 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 / $295.12 / $602.56
| Professional | TC | $218.78 | $295.12 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $630.96 / $776.25
| Professional | | $363.08 | $630.96 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $251.19
| Professional | 26 | $102.33 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $524.81
| Professional | TC | $257.04 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $1,000.00
| Professional | | $426.58 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $295.12
| Professional | 26 | $131.83 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $741.31
| Professional | TC | $275.42 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $676.08
| Professional | | $501.19 | $501.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $204.17
| Professional | 26 | $165.96 | $165.96 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $467.74
| Professional | TC | $331.13 | $331.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $354.81 / $660.69
| Professional | | $295.12 | $354.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $501.19 / $1,023.29
| Professional | | $316.23 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $302.00
| Professional | 26 | $97.72 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $724.44
| Professional | TC | $223.87 | $363.08 | $724.44 |