- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $104.71 / $181.97
| Facility | 26 | $97.72 | $104.71 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $758.58
| Professional | | $338.84 | $501.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $234.42
| Professional | 26 | $97.72 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $398.11
| Professional | 52 | $323.59 | $323.59 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $275.42 / $512.86
| Professional | TC | $229.09 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $776.25 / $870.96
| Professional | | $616.60 | $776.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $263.03
| Professional | 26 | $186.21 | $234.42 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $602.56
| Professional | TC | $436.52 | $549.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $1,071.52
| Professional | | $512.86 | $660.69 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $194.98 / $309.03
| Professional | 26 | $147.91 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $478.63 / $758.58
| Professional | TC | $363.08 | $478.63 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $575.44 / $776.25
| Professional | | $316.23 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $229.09
| Professional | 26 | $109.65 | $190.55 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $380.19 / $537.03
| Professional | TC | $199.53 | $380.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $602.56 / $891.25
| Professional | | $316.23 | $602.56 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $269.15
| Professional | 26 | $109.65 | $181.97 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $630.96
| Professional | TC | $199.53 | $398.11 | $630.96 |