- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $128.82
| Facility | 26 | $79.43 | $109.65 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $338.84 / $630.96
| Professional | | $208.93 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $245.47
| Professional | 26 | $67.61 | $112.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | 52 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $213.80 / $426.58
| Professional | TC | $125.89 | $213.80 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Professional | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $89.13
| Professional | 26 | $52.48 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | TC | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $194.98 / $269.15
| Professional | | $70.79 | $194.98 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $117.49
| Facility | 26 | $72.44 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $371.54 / $575.44
| Professional | | $169.82 | $371.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $77.62 / $125.89
| Professional | 26 | $63.10 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $257.04 / $467.74
| Professional | TC | $109.65 | $257.04 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $660.69 / $660.69
| Facility | 26 | $512.86 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $2,884.03
| Professional | | $190.55 | $288.40 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $562.34
| Professional | 26 | $64.57 | $83.18 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $263.03 / $2,511.89
| Professional | TC | $125.89 | $263.03 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $223.87 / $549.54
| Professional | | $177.83 | $223.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $144.54
| Professional | 26 | $64.57 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $151.36 / $478.63
| Professional | TC | $114.82 | $151.36 | $478.63 |