- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $380.19
| Facility | 26 | $100.00 | $109.65 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $478.63 / $1,174.90
| Professional | | $251.19 | $478.63 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $239.88
| Professional | 26 | $67.61 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $1,995.26
| Professional | 52 | $147.91 | $213.80 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $309.03 / $562.34
| Professional | TC | $169.82 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $323.59 / $398.11
| Professional | | $158.49 | $323.59 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $158.49
| Professional | 26 | $51.29 | $64.57 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $758.58
| Professional | | $223.87 | $363.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $173.78
| Professional | 26 | $69.18 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $398.11 / $645.65
| Professional | TC | $223.87 | $398.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $776.25
| Professional | | $229.09 | $457.09 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $169.82
| Professional | 26 | $60.26 | $100.00 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $354.81 / $616.60
| Professional | TC | $158.49 | $354.81 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 26 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $3,630.78
| Professional | | $2,951.21 | $2,951.21 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | 26 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,570.40
| Professional | TC | $2,511.89 | $2,511.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $676.08
| Professional | | $251.19 | $446.68 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $83.18 / $147.91
| Professional | 26 | $67.61 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $323.59 / $512.86
| Professional | TC | $173.78 | $323.59 | $512.86 |