- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $125.89 / $660.69
| Facility | 26 | $112.20 | $125.89 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $1,000.00
| Professional | | $549.54 | $691.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $158.49 / $489.78
| Professional | 26 | $112.20 | $158.49 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $109.65 / $245.47 / $245.47
| Professional | 52 | $109.65 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $794.33
| Professional | TC | $436.52 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $588.84 / $1,348.96
| Professional | | $549.54 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $269.15
| Professional | 26 | $104.71 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $933.25 / $1,202.26
| Professional | | $602.56 | $933.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $295.12
| Professional | 26 | $128.82 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $724.44 / $954.99
| Professional | TC | $457.09 | $724.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $97.72
| Professional | | $32.36 | $33.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $758.58 / $1,122.02
| Professional | | $524.81 | $758.58 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $275.42
| Professional | 26 | $107.15 | $162.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $870.96
| Professional | TC | $426.58 | $575.44 | $870.96 |