- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $186.21 / $501.19
| Facility | 26 | $85.11 | $186.21 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $1,905.46
| Professional | | $323.59 | $501.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $478.63
| Professional | 26 | $97.72 | $165.96 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $138.04 / $165.96 / $239.88
| Professional | 52 | $138.04 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $870.96
| Professional | TC | $208.93 | $338.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $588.84
| Professional | | $234.42 | $380.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $147.91 / $199.53
| Professional | 26 | $91.20 | $147.91 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $269.15
| Professional | TC | $162.18 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $1,479.11
| Professional | | $363.08 | $588.84 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $151.36 / $239.88
| Professional | 26 | $97.72 | $151.36 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $407.38 / $1,258.93
| Professional | TC | $263.03 | $407.38 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $398.11
| Professional | | $112.20 | $229.09 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $758.58 / $1,659.59
| Professional | | $309.03 | $758.58 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $295.12
| Professional | 26 | $97.72 | $165.96 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $512.86 / $1,258.93
| Professional | TC | $218.78 | $512.86 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $416.87 / $2,511.89
| Professional | | $323.59 | $416.87 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 22
- Typical Low / Median / Typical High
- $977.24 / $977.24 / $1,380.38
| Professional | 22 | $977.24 | $977.24 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $478.63
| Professional | 26 | $107.15 | $144.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $407.38
| Professional | 52 | $288.40 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $281.84 / $2,041.74
| Professional | TC | $213.80 | $281.84 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $302.00 / $588.84
| Professional | | $112.20 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $602.56 / $1,380.38
| Professional | | $323.59 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $257.04
| Professional | 26 | $100.00 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $389.05 / $1,096.48
| Professional | TC | $218.78 | $389.05 | $1,096.48 |