- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $190.55 / $281.84
| Facility | 26 | $147.91 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $501.19 / $2,238.72
| Professional | | $218.78 | $501.19 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $151.36 / $588.84
| Professional | 26 | $67.61 | $151.36 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $177.83
| Professional | 52 | $141.25 | $141.25 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $275.42 / $501.19
| Professional | TC | $128.82 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $389.05 / $1,122.02
| Professional | | $190.55 | $389.05 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $398.11
| Professional | 26 | $67.61 | $109.65 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $251.19 / $794.33
| Professional | TC | $123.03 | $251.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $239.88
| Professional | | $89.13 | $147.91 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $213.80 / $338.84
| Facility | 26 | $181.97 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $602.56 / $851.14
| Professional | | $251.19 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $173.78 / $281.84
| Professional | 26 | $77.62 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $436.52 / $512.86
| Professional | TC | $165.96 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $575.44
| Professional | | $354.81 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $154.88 / $208.93
| Professional | 26 | $128.82 | $154.88 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $380.19
| Professional | TC | $229.09 | $269.15 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $1,659.59
| Facility | 26 | $660.69 | $660.69 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $616.60 / $2,884.03
| Professional | | $251.19 | $616.60 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $194.98 / $630.96
| Professional | 26 | $85.11 | $194.98 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $2,511.89
| Professional | TC | $165.96 | $416.87 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $467.74
| Professional | | $32.36 | $33.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $588.84 / $1,000.00
| Professional | | $245.47 | $588.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $165.96 / $281.84
| Professional | 26 | $100.00 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $467.74 / $831.76
| Professional | TC | $190.55 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $478.63 / $2,041.74
| Professional | | $251.19 | $478.63 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $645.65 / $645.65
| Facility | 26 | $162.18 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $1,659.59 / $3,019.95
| Professional | | $295.12 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $363.08 / $562.34
| Professional | 26 | $102.33 | $363.08 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $1,412.54 / $2,570.40
| Professional | TC | $177.83 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | 26 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | TC | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,737.80 / $2,691.53
| Professional | | $1,258.93 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $912.01
| Professional | 26 | $302.00 | $446.68 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $1,445.44 / $1,778.28
| Professional | TC | $707.95 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $954.99 / $1,513.56
| Professional | | $95.50 | $954.99 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $354.81 / $537.03
| Professional | 26 | $87.10 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $436.52 / $1,071.52
| Professional | TC | $95.50 | $436.52 | $1,071.52 |