- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $123.03
| Facility | 26 | $100.00 | $120.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $426.58 / $912.01
| Professional | | $208.93 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $123.03 / $257.04
| Professional | 26 | $66.07 | $123.03 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | 52 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $218.78 / $467.74
| Professional | TC | $120.23 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $190.55 / $295.12
| Professional | | $91.20 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $67.61 / $109.65
| Professional | 26 | $56.23 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $93.33 / $95.50
| Professional | TC | $81.28 | $93.33 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $309.03
| Professional | | $213.80 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $112.20
| Professional | 26 | $75.86 | $87.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $154.88 / $199.53
| Professional | TC | $134.90 | $154.88 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $281.84
| Professional | | $77.62 | $147.91 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $114.82
| Facility | 26 | $16.98 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $416.87 / $776.25
| Professional | | $190.55 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $165.96
| Professional | 26 | $63.10 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $616.60
| Professional | TC | $123.03 | $257.04 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $346.74 / $389.05
| Professional | | $165.96 | $346.74 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $131.83 / $147.91
| Professional | 26 | $63.10 | $131.83 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $223.87
| Professional | TC | $169.82 | $208.93 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $741.31
| Professional | | $190.55 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $151.36
| Professional | 26 | $66.07 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $208.93 / $616.60
| Professional | TC | $125.89 | $208.93 | $616.60 |