- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $660.69 / $831.76
| Facility | 26 | $346.74 | $660.69 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $1,412.54
| Professional | | $275.42 | $501.19 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $389.05
| Professional | 26 | $102.33 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $457.09 / $489.78 / $1,047.13
| Professional | 52 | $457.09 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $323.59 / $1,000.00
| Professional | TC | $204.17 | $323.59 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,122.02 / $1,258.93
| Professional | | $467.74 | $1,122.02 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $213.80 / $371.54
| Professional | 26 | $91.20 | $213.80 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $812.83 / $1,122.02
| Professional | TC | $323.59 | $812.83 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $660.69 / $831.76
| Facility | 26 | $346.74 | $660.69 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $870.96 / $2,089.30
| Professional | | $457.09 | $870.96 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $316.23 / $741.31
| Professional | 26 | $128.82 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $457.09 / $489.78 / $1,047.13
| Professional | 52 | $457.09 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $562.34 / $1,288.25
| Professional | TC | $316.23 | $562.34 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,348.96 / $2,290.87
| Professional | | $1,318.26 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $436.52 / $724.44
| Professional | 26 | $398.11 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $933.25 / $1,584.89
| Professional | TC | $794.33 | $933.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $831.76 / $1,202.26
| Professional | | $562.34 | $831.76 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $338.84 / $371.54
| Professional | 26 | $107.15 | $338.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $794.33 / $1,148.15
| Professional | TC | $239.88 | $794.33 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $1,071.52 / $3,630.78
| Professional | | $380.19 | $1,071.52 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $323.59 / $724.44
| Professional | 26 | $120.23 | $323.59 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $707.95 / $2,818.38
| Professional | TC | $288.40 | $707.95 | $2,818.38 |