- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $281.84
| Facility | 26 | $114.82 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $398.11 / $1,202.26
| Professional | | $204.17 | $398.11 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $245.47
| Professional | 26 | $66.07 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $363.08
| Professional | 52 | $74.13 | $120.23 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $251.19 / $501.19
| Professional | TC | $131.83 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $478.63
| Professional | | $190.55 | $269.15 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $144.54
| Professional | 26 | $66.07 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $323.59
| Professional | TC | $125.89 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $288.40 / $1,584.89
| Professional | | $177.83 | $288.40 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $134.90
| Professional | 26 | $69.18 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $194.98 / $354.81
| Professional | TC | $177.83 | $194.98 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $416.87 / $758.58
| Professional | | $173.78 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $158.49
| Professional | 26 | $54.95 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $281.84 / $630.96
| Professional | TC | $117.49 | $281.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $229.09 / $302.00
| Professional | | $190.55 | $229.09 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $97.72
| Professional | 26 | $63.10 | $77.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $154.88 / $204.17
| Professional | TC | $125.89 | $154.88 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $776.25 / $794.33
| Professional | | $467.74 | $776.25 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $151.36
| Professional | 26 | $104.71 | $131.83 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $446.68
| Professional | | $331.13 | $331.13 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $331.13 / $1,778.28
| Professional | | $91.20 | $331.13 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $141.25
| Professional | 26 | $72.44 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $275.42 / $537.03
| Professional | TC | $147.91 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $331.13 / $831.76
| Professional | | $177.83 | $331.13 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $85.11 / $169.82
| Professional | 26 | $50.12 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $676.08
| Professional | TC | $120.23 | $229.09 | $676.08 |