- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $104.71 / $104.71
| Facility | 26 | $63.10 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $478.63 / $1,000.00
| Professional | | $251.19 | $478.63 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $138.04 / $251.19
| Professional | 26 | $67.61 | $138.04 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $512.86 / $1,995.26
| Professional | 52 | $147.91 | $512.86 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $288.40 / $616.60
| Professional | TC | $173.78 | $288.40 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $87.10
| Professional | 26 | $51.29 | $75.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $436.52 / $524.81
| Professional | | $162.18 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $169.82
| Professional | 26 | $93.33 | $131.83 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $309.03 / $363.08
| Professional | TC | $112.20 | $309.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $794.33
| Professional | | $251.19 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $104.71 / $181.97
| Professional | 26 | $58.88 | $104.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $338.84 / $588.84
| Professional | TC | $173.78 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $691.83
| Professional | | $199.53 | $295.12 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $138.04
| Professional | 26 | $57.54 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $602.56
| Professional | TC | $151.36 | $213.80 | $602.56 |