- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $48.98 / $77.62
| Facility | 26 | $33.88 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $144.54 / $562.34
| Professional | | $45.71 | $144.54 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $141.25
| Professional | 26 | $33.88 | $58.88 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $95.50 / $109.65 / $147.91
| Professional | 52 | $95.50 | $109.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $446.68
| Professional | TC | $74.13 | $104.71 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $302.00 / $380.19
| Professional | | $141.25 | $302.00 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $89.13 / $112.20
| Professional | 26 | $41.69 | $89.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $213.80 / $263.03
| Professional | TC | $95.50 | $213.80 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $204.17 / $575.44
| Professional | | $125.89 | $204.17 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $66.07 / $141.25
| Professional | 26 | $38.90 | $66.07 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $478.63
| Professional | TC | $85.11 | $141.25 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $173.78 / $173.78
| Facility | 26 | $128.82 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $234.42 / $812.83
| Professional | | $138.04 | $234.42 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $239.88
| Professional | 26 | $41.69 | $57.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $117.49 / $562.34
| Professional | TC | $89.13 | $117.49 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $489.78
| Professional | | $245.47 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $147.91
| Professional | 26 | $75.86 | $95.50 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $338.84
| Professional | TC | $169.82 | $208.93 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $302.00 / $489.78
| Professional | | $245.47 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $95.50 / $147.91
| Professional | 26 | $77.62 | $95.50 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $338.84
| Professional | TC | $169.82 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $89.13 / $208.93
| Professional | | $39.81 | $89.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $338.84
| Professional | | $125.89 | $173.78 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $104.71
| Professional | 26 | $40.74 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $123.03 / $245.47
| Professional | TC | $89.13 | $123.03 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $275.42
| Professional | | $234.42 | $234.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $83.18
| Professional | 26 | $70.79 | $70.79 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $190.55
| Professional | TC | $162.18 | $162.18 | $190.55 |