- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $302.00
| Facility | 26 | $67.61 | $109.65 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $354.81 / $1,258.93
| Professional | | $97.72 | $354.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $128.82 / $363.08
| Professional | 26 | $63.10 | $128.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $478.63 / $1,778.28
| Professional | 50 | $251.19 | $478.63 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $31.62 / $162.18 / $1,023.29
| Professional | 52 | $31.62 | $162.18 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $707.95
| Professional | TC | $141.25 | $295.12 | $707.95 |
- 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
- $204.17 / $380.19 / $776.25
| Professional | | $204.17 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $158.49
| Professional | 26 | $63.10 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $309.03 / $489.78 / $1,071.52
| Professional | 50 | $309.03 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $660.69
| Professional | TC | $147.91 | $281.84 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $83.18 / $223.87
| Facility | 26 | $15.49 | $83.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $794.33
| Professional | | $194.98 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $181.97
| Professional | 26 | $52.48 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $758.58
| Professional | 50 | $302.00 | $346.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $295.12 / $645.65
| Professional | TC | $138.04 | $295.12 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $1,000.00
| Professional | | $194.98 | $331.13 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $302.00
| Professional | 26 | $54.95 | $83.18 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $724.44
| Professional | TC | $134.90 | $234.42 | $724.44 |