- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $123.03 / $147.91
| Facility | 26 | $66.07 | $123.03 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $467.74 / $1,778.28
| Professional | | $194.98 | $467.74 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $389.05
| Professional | 26 | $64.57 | $107.15 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $151.36 / $1,230.27 / $1,380.38
| Professional | 52 | $151.36 | $1,230.27 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $302.00 / $831.76
| Professional | TC | $123.03 | $302.00 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $467.74 / $870.96
| Professional | | $275.42 | $467.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $162.18 / $208.93
| Professional | 26 | $70.79 | $162.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $323.59 / $707.95
| Professional | TC | $173.78 | $323.59 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $371.54 / $1,479.11
| Professional | | $173.78 | $371.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $363.08
| Professional | 26 | $64.57 | $125.89 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $245.47 / $1,288.25
| Professional | TC | $112.20 | $245.47 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $660.69
| Facility | 26 | $512.86 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $501.19 / $3,162.28
| Professional | | $239.88 | $501.19 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $575.44
| Professional | 26 | $72.44 | $123.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $354.81 / $2,754.23
| Professional | TC | $144.54 | $354.81 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $602.56 / $933.25
| Professional | | $389.05 | $602.56 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $239.88
| Professional | 26 | $141.25 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $389.05 / $776.25
| Professional | TC | $245.47 | $389.05 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $602.56 / $758.58
| Professional | | $457.09 | $602.56 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $218.78
| Professional | 26 | $128.82 | $173.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $630.96
| Professional | TC | $295.12 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $147.91 / $323.59
| Professional | | $70.79 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $1,288.25
| Professional | | $208.93 | $354.81 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $407.38
| Professional | 26 | $74.13 | $120.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $229.09 / $831.76
| Professional | TC | $138.04 | $229.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $512.86
| Professional | | $436.52 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $181.97
| Professional | 26 | $154.88 | $154.88 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $323.59
| Professional | TC | $275.42 | $275.42 | $323.59 |