- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $104.71
| Facility | 26 | $66.07 | $66.07 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $234.42 / $1,548.82
| Professional | | $107.15 | $234.42 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $269.15
| Professional | 26 | $61.66 | $125.89 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | 50 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | 52 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $275.42 / $562.34
| Professional | TC | $141.25 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $199.53 / $426.58
| Professional | | $83.18 | $199.53 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $72.44 / $104.71
| Facility | 26 | $15.49 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $501.19 / $2,089.30
| Professional | | $169.82 | $501.19 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $93.33 / $316.23
| Professional | 26 | $51.29 | $93.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $338.84 / $1,548.82
| Professional | TC | $114.82 | $338.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $169.82
| Professional | 26 | $100.00 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $363.08 / $851.14
| Professional | | $165.96 | $363.08 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $77.62 / $134.90
| Professional | 26 | $39.81 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $275.42 / $741.31
| Professional | TC | $123.03 | $275.42 | $741.31 |