- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $2,238.72
| Facility | 26 | $64.57 | $125.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $269.15 / $933.25
| Professional | | $74.13 | $269.15 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $125.89 / $302.00
| Professional | 26 | $63.10 | $125.89 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | 50 | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $102.33
| Professional | 52 | $100.00 | $100.00 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $263.03 / $501.19
| Professional | TC | $141.25 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $645.65
| Professional | | $199.53 | $398.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $75.86 / $134.90
| Professional | 26 | $45.71 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $575.44
| Professional | TC | $141.25 | $295.12 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $208.93 / $257.04
| Professional | | $204.17 | $208.93 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $676.08
| Professional | 26 | $63.10 | $107.15 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Professional | TC | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $309.03 / $1,047.13
| Professional | | $79.43 | $309.03 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $323.59
| Professional | 26 | $54.95 | $81.28 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $380.19 / $724.44
| Professional | TC | $138.04 | $380.19 | $724.44 |