- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $67.61 / $109.65
| Facility | 26 | $64.57 | $67.61 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $346.74 / $707.95
| Professional | | $131.83 | $346.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $138.04 / $275.42
| Professional | 26 | $61.66 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $302.00 / $575.44
| Professional | TC | $165.96 | $302.00 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $575.44
| Professional | | $398.11 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $162.18
| Professional | 26 | $109.65 | $147.91 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $794.33 / $1,047.13 / $1,174.90
| Professional | 50 | $794.33 | $1,047.13 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $416.87
| Professional | TC | $281.84 | $380.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $758.58
| Professional | | $281.84 | $436.52 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $165.96
| Professional | 26 | $64.57 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $316.23 / $575.44
| Professional | TC | $204.17 | $316.23 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | 26 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $588.84 / $2,818.38
| Professional | | $263.03 | $588.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $128.82 / $537.03
| Professional | 26 | $69.18 | $128.82 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $478.63 / $2,454.71
| Professional | TC | $190.55 | $478.63 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $416.87 / $741.31
| Professional | | $223.87 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $169.82
| Professional | 26 | $67.61 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $331.13 / $602.56
| Professional | TC | $100.00 | $331.13 | $602.56 |