- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $114.82 / $323.59
| Facility | 26 | $85.11 | $114.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $426.58 / $1,023.29
| Professional | | $181.97 | $426.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $275.42
| Professional | 26 | $66.07 | $112.20 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $870.96
| Professional | 52 | $123.03 | $199.53 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $257.04 / $562.34
| Professional | TC | $109.65 | $257.04 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $331.13
| Professional | | $144.54 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $128.82
| Professional | 26 | $57.54 | $91.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $213.80
| Professional | TC | $81.28 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $467.74 / $776.25
| Professional | | $218.78 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $162.18
| Professional | 26 | $74.13 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $316.23 / $630.96
| Professional | TC | $151.36 | $316.23 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $131.83 / $239.88
| Professional | | $72.44 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $933.25
| Professional | | $194.98 | $478.63 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $204.17
| Professional | 26 | $63.10 | $109.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $309.03 / $724.44
| Professional | TC | $123.03 | $309.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $251.19 / $1,348.96
| Professional | | $194.98 | $251.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $93.33 / $251.19
| Professional | 26 | $69.18 | $93.33 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $239.88
| Professional | 52 | $169.82 | $169.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $162.18 / $1,174.90
| Professional | TC | $125.89 | $162.18 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $177.83 / $346.74
| Professional | | $72.44 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $363.08 / $794.33
| Professional | | $199.53 | $363.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $169.82
| Professional | 26 | $66.07 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $575.44
| Professional | TC | $125.89 | $229.09 | $575.44 |