- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $338.84
| Facility | 26 | $134.90 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $1,479.11
| Professional | | $245.47 | $478.63 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $138.04 / $302.00
| Professional | 26 | $69.18 | $138.04 | $302.00 |
- 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
- $169.82 / $288.40 / $660.69
| Professional | TC | $169.82 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $190.55 / $194.98
| Professional | | $173.78 | $190.55 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $95.50
| Professional | 26 | $51.29 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | TC | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $331.13 / $524.81
| Professional | | $263.03 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $85.11 / $138.04
| Professional | 26 | $69.18 | $85.11 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $389.05
| Professional | TC | $194.98 | $245.47 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $112.20
| Facility | 26 | $16.98 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $758.58
| Professional | | $194.98 | $407.38 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $147.91
| Professional | 26 | $52.48 | $79.43 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $309.03 / $616.60
| Professional | TC | $138.04 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $501.19 / $645.65 / $645.65
| Facility | 26 | $501.19 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $3,467.37
| Professional | | $229.09 | $478.63 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $575.44
| Professional | 26 | $58.88 | $77.62 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $416.87 / $2,454.71
| Professional | TC | $165.96 | $416.87 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $676.08
| Professional | | $213.80 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $169.82
| Professional | 26 | $58.88 | $75.86 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $275.42 / $489.78
| Professional | TC | $165.96 | $275.42 | $489.78 |