- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $489.78
| Facility | 26 | $81.28 | $97.72 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $478.63 / $977.24
| Professional | | $239.88 | $478.63 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $125.89 / $234.42
| Professional | 26 | $66.07 | $125.89 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $870.96
| Professional | 52 | $158.49 | $158.49 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $263.03 / $616.60
| Professional | TC | $125.89 | $263.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $281.84 / $707.95
| Professional | | $190.55 | $281.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $229.09
| Professional | 26 | $67.61 | $100.00 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $457.09
| Professional | TC | $123.03 | $177.83 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $562.34 / $794.33
| Professional | | $257.04 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $109.65 / $208.93
| Professional | 26 | $72.44 | $109.65 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $389.05 / $660.69
| Professional | TC | $165.96 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $288.40 / $549.54
| Professional | | $223.87 | $288.40 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $104.71 / $194.98
| Professional | 26 | $83.18 | $104.71 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $190.55 / $363.08
| Professional | TC | $147.91 | $190.55 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $165.96 / $9,772.37
| Facility | 26 | $81.28 | $165.96 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $870.96
| Professional | | $234.42 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $218.78
| Professional | 26 | $85.11 | $125.89 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $263.03 / $588.84
| Professional | TC | $147.91 | $263.03 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $302.00 / $676.08
| Professional | | $173.78 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $269.15
| Professional | 26 | $74.13 | $107.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $199.53 / $512.86
| Professional | TC | $123.03 | $199.53 | $512.86 |