- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $87.10 / $144.54
| Facility | 26 | $83.18 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $691.83
| Professional | | $190.55 | $295.12 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $114.82 / $316.23
| Professional | 26 | $79.43 | $114.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $173.78
| Professional | 50 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $218.78 / $512.86
| Professional | TC | $162.18 | $218.78 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $977.24
| Professional | | $398.11 | $794.33 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $208.93 / $257.04
| Professional | 26 | $91.20 | $208.93 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $575.44 / $724.44
| Professional | TC | $309.03 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $575.44 / $1,348.96
| Professional | | $295.12 | $575.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $446.68
| Professional | 26 | $83.18 | $162.18 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $457.09 / $1,047.13
| Professional | TC | $213.80 | $457.09 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $645.65 / $831.76 / $831.76
| Facility | 26 | $645.65 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $616.60 / $2,884.03
| Professional | | $363.08 | $616.60 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $138.04 / $562.34
| Professional | 26 | $91.20 | $138.04 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $426.58 / $2,398.83
| Professional | TC | $251.19 | $426.58 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $660.69 / $954.99
| Professional | | $524.81 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $275.42
| Professional | 26 | $177.83 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $436.52 / $758.58
| Professional | TC | $346.74 | $436.52 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | 26 | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $912.01
| Professional | | $645.65 | $794.33 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $208.93 / $239.88
| Professional | 26 | $165.96 | $208.93 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $630.96 / $676.08
| Professional | TC | $426.58 | $630.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $239.88 / $549.54
| Professional | | $91.20 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $478.63 / $933.25
| Professional | | $346.74 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $288.40
| Professional | 26 | $93.33 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $363.08 / $691.83
| Professional | TC | $251.19 | $363.08 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $630.96 / $741.31
| Professional | | $630.96 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $199.53
| Professional | 26 | $169.82 | $169.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $537.03
| Professional | TC | $457.09 | $457.09 | $537.03 |