- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $75.86
| Facility | 26 | $58.88 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $181.97 / $575.44
| Professional | | $72.44 | $181.97 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $218.78
| Professional | 26 | $45.71 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $199.53 / $199.53
| Professional | 50 | $177.83 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $165.96 / $338.84
| Professional | TC | $102.33 | $165.96 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $295.12
| Professional | | $125.89 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $54.95 / $89.13
| Professional | 26 | $37.15 | $54.95 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $489.78
| Professional | | $245.47 | $263.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $100.00
| Professional | 26 | $74.13 | $74.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $707.95
| Professional | 50 | $524.81 | $524.81 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $251.19
| Professional | TC | $186.21 | $186.21 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $138.04 / $229.09
| Professional | | $52.48 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $457.09
| Professional | | $158.49 | $251.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $63.10 / $123.03
| Professional | 26 | $37.15 | $63.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $380.19
| Professional | 50 | $229.09 | $263.03 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $346.74
| Professional | TC | $112.20 | $173.78 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $107.15
| Facility | 26 | $58.88 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $457.09
| Professional | | $131.83 | $208.93 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $162.18
| Professional | 26 | $44.67 | $66.07 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $199.53
| Professional | 50 | $177.83 | $177.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $165.96 / $316.23
| Professional | TC | $112.20 | $165.96 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $194.98 / $407.38
| Professional | | $147.91 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $87.10
| Professional | 26 | $39.81 | $58.88 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $229.09 / $263.03 / $398.11
| Professional | 50 | $229.09 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $263.03
| Professional | TC | $104.71 | $158.49 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $218.78 / $660.69
| Professional | | $117.49 | $218.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $295.12
| Professional | 26 | $46.77 | $61.66 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $158.49 / $281.84
| Professional | TC | $114.82 | $158.49 | $281.84 |