- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $131.83 / $707.95
| Facility | 26 | $117.49 | $131.83 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $724.44 / $1,047.13
| Professional | | $575.44 | $724.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $346.74
| Professional | 26 | $117.49 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | 52 | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $575.44 / $831.76
| Professional | TC | $457.09 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $1,412.54
| Professional | | $616.60 | $616.60 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $154.88 / $177.83
| Professional | 26 | $112.20 | $154.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $512.86 / $512.86
| Professional | TC | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,258.93
| Professional | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $977.24 / $1,288.25
| Professional | | $645.65 | $977.24 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $208.93 / $309.03
| Professional | 26 | $134.90 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $758.58 / $1,023.29
| Professional | TC | $501.19 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $100.00
| Professional | | $32.36 | $33.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $812.83 / $1,230.27
| Professional | | $549.54 | $812.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $295.12
| Professional | 26 | $112.20 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $977.24
| Professional | TC | $446.68 | $630.96 | $977.24 |