- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $70.79 / $123.03
| Facility | 26 | $66.07 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $1,412.54
| Professional | | $199.53 | $398.11 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $100.00 / $251.19
| Professional | 26 | $66.07 | $100.00 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $147.91
| Professional | 52 | $75.86 | $112.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $239.88 / $501.19
| Professional | TC | $131.83 | $239.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $58.88 / $58.88
| Facility | 26 | $48.98 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $724.44
| Professional | | $331.13 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $173.78 / $251.19
| Professional | 26 | $114.82 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $346.74 / $467.74
| Professional | TC | $218.78 | $346.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $251.19 / $616.60
| Facility | 26 | $114.82 | $251.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $61.66
| Facility | 53 | $22.91 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $389.05 / $870.96
| Professional | | $309.03 | $389.05 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $131.83 / $218.78
| Professional | 26 | $79.43 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $676.08
| Professional | TC | $204.17 | $257.04 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $245.47 / $478.63
| Facility | 26 | $199.53 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $831.76
| Professional | | $309.03 | $309.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $186.21
| Professional | 26 | $104.71 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $549.54
| Professional | TC | $204.17 | $204.17 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 26 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $562.34 / $2,884.03
| Professional | | $251.19 | $562.34 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $177.83 / $588.84
| Professional | 26 | $93.33 | $177.83 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $630.96 / $1,230.27 / $1,862.09
| Professional | 52 | $630.96 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $354.81 / $2,511.89
| Professional | TC | $151.36 | $354.81 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $645.65 / $1,698.24
| Professional | | $229.09 | $645.65 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $575.44
| Professional | 26 | $83.18 | $144.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $446.68 / $1,122.02
| Professional | TC | $151.36 | $446.68 | $1,122.02 |