- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $97.72
| Facility | 26 | $52.48 | $83.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $371.54 / $1,000.00
| Professional | | $194.98 | $371.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $109.65 / $309.03
| Professional | 26 | $60.26 | $109.65 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Professional | 50 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $549.54
| Professional | TC | $162.18 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $302.00
| Professional | | $147.91 | $177.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $61.66 / $120.23
| Professional | 26 | $47.86 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | TC | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $169.82 / $234.42
| Professional | | $48.98 | $169.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $288.40 / $575.44
| Professional | | $208.93 | $288.40 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $64.57
| Professional | 26 | $60.26 | $60.26 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $72.44 / $104.71
| Facility | 26 | $15.49 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $776.25
| Professional | | $213.80 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $144.54
| Professional | 26 | $53.70 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $302.00 / $630.96
| Professional | TC | $154.88 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $407.38
| Facility | 26 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,951.21
| Professional | | $2,884.03 | $2,884.03 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | 26 | $549.54 | $549.54 | $549.54 |
- 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
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $109.65
| Facility | 26 | $54.95 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $371.54 / $870.96
| Professional | | $208.93 | $371.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $204.17
| Professional | 26 | $58.88 | $102.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Professional | 50 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $263.03 / $562.34
| Professional | TC | $158.49 | $263.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $186.21
| Professional | | $32.36 | $33.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $213.80 / $691.83
| Professional | | $64.57 | $213.80 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $74.13 / $104.71
| Facility | 26 | $15.85 | $74.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $398.11 / $741.31
| Professional | | $213.80 | $398.11 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $134.90
| Professional | 26 | $53.70 | $79.43 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $616.60
| Professional | TC | $147.91 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $363.08 / $724.44
| Professional | | $223.87 | $363.08 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $151.36
| Professional | 26 | $54.95 | $69.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $575.44
| Professional | TC | $162.18 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $263.03
| Professional | | $213.80 | $223.87 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $63.10 / $75.86
| Professional | 26 | $60.26 | $63.10 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $190.55
| Professional | TC | $158.49 | $158.49 | $190.55 |