- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $173.78
| Facility | 26 | $125.89 | $125.89 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $1,995.26
| Professional | | $316.23 | $512.86 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $190.55 / $512.86
| Professional | 26 | $100.00 | $190.55 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $239.88
| Professional | 52 | $138.04 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $371.54 / $1,412.54
| Professional | TC | $218.78 | $371.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $588.84
| Professional | | $302.00 | $457.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $134.90 / $165.96
| Professional | 26 | $123.03 | $134.90 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $323.59 / $407.38
| Professional | TC | $288.40 | $323.59 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | 26 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $549.54 / $1,318.26
| Professional | | $281.84 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $125.89 / $229.09
| Professional | 26 | $83.18 | $125.89 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $389.05 / $1,122.02
| Professional | TC | $194.98 | $389.05 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $380.19 / $707.95
| Professional | | $331.13 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $120.23 / $162.18
| Professional | 26 | $104.71 | $120.23 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $537.03
| Professional | TC | $223.87 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $478.63 / $1,122.02
| Professional | | $316.23 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $120.23 / $251.19
| Professional | 26 | $77.62 | $120.23 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $346.74 / $977.24
| Professional | TC | $223.87 | $346.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $363.08 / $524.81
| Professional | | $338.84 | $363.08 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $114.82 / $165.96
| Professional | 26 | $109.65 | $114.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $251.19 / $363.08
| Professional | TC | $223.87 | $251.19 | $363.08 |