- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $186.21
| Facility | 26 | $64.57 | $81.28 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $588.84
| Professional | | $354.81 | $426.58 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $89.13
| Professional | 26 | $52.48 | $63.10 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $95.50 / $95.50
| Professional | 52 | $28.18 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $512.86
| Professional | TC | $295.12 | $363.08 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $870.96
| Professional | | $389.05 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $120.23
| Professional | 26 | $56.23 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $457.09 / $741.31
| Professional | TC | $338.84 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $575.44 / $1,000.00
| Professional | | $354.81 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $147.91
| Professional | 26 | $54.95 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $478.63 / $831.76
| Professional | TC | $309.03 | $478.63 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $66.07 / $95.50
| Facility | 26 | $14.13 | $66.07 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $954.99
| Professional | | $354.81 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $147.91
| Professional | 26 | $54.95 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $457.09 / $812.83
| Professional | TC | $309.03 | $457.09 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | 26 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $501.19 / $954.99
| Professional | | $426.58 | $501.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $134.90
| Professional | 26 | $61.66 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $812.83
| Professional | TC | $371.54 | $436.52 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $812.83
| Professional | | $354.81 | $501.19 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $125.89
| Professional | 26 | $52.48 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $691.83
| Professional | TC | $302.00 | $416.87 | $691.83 |