- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $77.62 / $186.21
| Facility | 26 | $53.70 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $851.14
| Professional | | $125.89 | $239.88 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $190.55
| Professional | 26 | $46.77 | $58.88 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $144.54 / $144.54
| Professional | 52 | $69.18 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $363.08
| Professional | TC | $79.43 | $128.82 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $223.87
| Professional | | $97.72 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $51.29 / $75.86
| Professional | 26 | $38.90 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $141.25
| Professional | TC | $63.10 | $75.86 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $158.49 / $302.00
| Professional | | $64.57 | $158.49 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Facility | 26 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $223.87 / $426.58
| Professional | | $134.90 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $102.33
| Professional | 26 | $42.66 | $70.79 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $309.03
| Professional | TC | $83.18 | $147.91 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $371.54 / $1,819.70
| Professional | | $154.88 | $371.54 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $467.74
| Professional | 26 | $60.26 | $104.71 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $239.88 / $1,479.11
| Professional | TC | $97.72 | $239.88 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $177.83
| Professional | | $162.18 | $162.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $63.10 / $66.07
| Professional | 26 | $61.66 | $63.10 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $102.33 / $109.65
| Professional | TC | $97.72 | $102.33 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $234.42 / $512.86
| Professional | | $134.90 | $234.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $218.78
| Professional | 26 | $56.23 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $338.84
| Professional | TC | $95.50 | $151.36 | $338.84 |