- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $141.25
| Facility | 26 | $100.00 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $2,884.03
| Professional | | $724.44 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $186.21 / $549.54
| Professional | 26 | $109.65 | $186.21 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $891.25 / $1,000.00
| Professional | 52 | $275.42 | $891.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | 53 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $776.25 / $1,698.24
| Professional | TC | $616.60 | $776.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $707.95 / $912.01
| Professional | | $616.60 | $707.95 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $194.98
| Professional | 26 | $104.71 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $758.58 / $954.99
| Professional | TC | $676.08 | $758.58 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | 26 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,071.52 / $1,819.70
| Professional | | $660.69 | $1,071.52 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $331.13
| Professional | 26 | $104.71 | $190.55 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $891.25 / $1,621.81
| Professional | TC | $562.34 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $977.24 / $1,288.25
| Professional | | $851.14 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $134.90 / $213.80
| Professional | 26 | $123.03 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $831.76 / $1,096.48
| Professional | TC | $724.44 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,047.13 / $1,819.70
| Professional | | $741.31 | $1,047.13 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $281.84
| Professional | 26 | $112.20 | $169.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $891.25 / $1,548.82
| Professional | TC | $616.60 | $891.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $933.25 / $1,258.93
| Professional | | $724.44 | $933.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $177.83
| Professional | 26 | $112.20 | $128.82 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $812.83 / $1,096.48
| Professional | TC | $616.60 | $812.83 | $1,096.48 |