- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $309.03
| Facility | 26 | $186.21 | $263.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $380.19 / $1,548.82
| Professional | | $85.11 | $380.19 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $309.03
| Professional | 26 | $64.57 | $125.89 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $660.69 / $1,230.27 / $2,041.74
| Professional | 50 | $660.69 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $1,047.13
| Professional | 52 | $288.40 | $288.40 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $302.00 / $812.83
| Professional | TC | $151.36 | $302.00 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $549.54 / $1,000.00
| Professional | | $223.87 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $125.89 / $173.78
| Professional | 26 | $63.10 | $125.89 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $812.83 / $1,513.56
| Professional | 50 | $323.59 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $363.08 / $794.33
| Professional | TC | $154.88 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $602.56 / $851.14
| Professional | | $295.12 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $190.55
| Professional | 26 | $61.66 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $467.74 / $676.08
| Professional | TC | $204.17 | $467.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $616.60 / $1,047.13
| Professional | | $295.12 | $616.60 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $102.33
| Professional | 26 | $70.79 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $562.34
| Professional | TC | $194.98 | $245.47 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $114.82 / $933.25
| Professional | | $60.26 | $114.82 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $316.23 / $1,096.48
| Professional | | $199.53 | $316.23 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $245.47
| Professional | 26 | $58.88 | $83.18 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $218.78 / $851.14
| Professional | TC | $138.04 | $218.78 | $851.14 |