- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $67.61
| Facility | 26 | $28.84 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $223.87 / $489.78
| Professional | | $104.71 | $223.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $66.07 / $177.83
| Professional | 26 | $30.20 | $66.07 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $74.13 / $177.83 / $363.08
| Professional | 52 | $74.13 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $346.74
| Professional | TC | $74.13 | $117.49 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $281.84 / $354.81
| Professional | | $107.15 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $77.62 / $95.50
| Professional | 26 | $33.11 | $77.62 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $204.17 / $257.04
| Professional | TC | $72.44 | $204.17 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $194.98 / $407.38
| Professional | | $114.82 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $77.62 / $154.88
| Professional | 26 | $33.11 | $77.62 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $128.82 / $281.84
| Professional | TC | $77.62 | $128.82 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $147.91 / $147.91
| Facility | 26 | $104.71 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $208.93 / $776.25
| Professional | | $109.65 | $208.93 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $288.40
| Professional | 26 | $33.11 | $51.29 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $107.15 / $575.44
| Professional | TC | $75.86 | $107.15 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $257.04 / $309.03
| Professional | | $208.93 | $257.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $100.00
| Professional | 26 | $66.07 | $81.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $186.21 / $223.87
| Professional | TC | $141.25 | $186.21 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | 26 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $275.42 / $371.54
| Professional | | $151.36 | $275.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $104.71
| Professional | 26 | $66.07 | $83.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $199.53 / $281.84
| Professional | TC | $83.18 | $199.53 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $87.10 / $199.53
| Professional | | $33.88 | $87.10 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $316.23
| Professional | | $100.00 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $100.00
| Professional | 26 | $33.88 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $213.80
| Professional | TC | $75.86 | $104.71 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $245.47
| Professional | | $208.93 | $208.93 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $69.18
| Professional | 26 | $57.54 | $57.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $177.83
| Professional | TC | $151.36 | $151.36 | $177.83 |