- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | 26 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $478.63 / $1,445.44
| Professional | | $204.17 | $478.63 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $269.15
| Professional | 26 | $66.07 | $97.72 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Professional | 52 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $309.03 / $616.60
| Professional | TC | $154.88 | $309.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $524.81
| Professional | | $199.53 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $147.91
| Professional | 26 | $70.79 | $91.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $213.80
| Professional | TC | $125.89 | $173.78 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $436.52 / $776.25
| Professional | | $208.93 | $436.52 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $131.83 / $154.88
| Professional | 26 | $64.57 | $131.83 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $281.84 / $630.96
| Professional | TC | $138.04 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $316.23 / $645.65
| Professional | | $218.78 | $316.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $112.20
| Professional | 26 | $66.07 | $83.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $190.55 / $467.74
| Professional | TC | $138.04 | $190.55 | $467.74 |