- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $123.03
| Facility | 26 | $77.62 | $114.82 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $398.11 / $954.99
| Professional | | $199.53 | $398.11 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $109.65 / $234.42
| Professional | 26 | $64.57 | $109.65 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | 52 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $223.87 / $478.63
| Professional | TC | $120.23 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $190.55 / $295.12
| Professional | | $151.36 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $69.18 / $112.20
| Professional | 26 | $56.23 | $69.18 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | TC | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $309.03
| Professional | | $213.80 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $112.20
| Professional | 26 | $75.86 | $87.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $154.88 / $199.53
| Professional | TC | $134.90 | $154.88 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $281.84
| Professional | | $77.62 | $147.91 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $114.82
| Facility | 26 | $16.98 | $79.43 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $416.87 / $831.76
| Professional | | $190.55 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $165.96
| Professional | 26 | $61.66 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $257.04 / $691.83
| Professional | TC | $123.03 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $338.84 / $380.19
| Professional | | $288.40 | $338.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $169.82
| Professional | 26 | $89.13 | $134.90 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $218.78 / $288.40
| Professional | TC | $208.93 | $218.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $338.84 / $812.83
| Professional | | $190.55 | $338.84 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $151.36
| Professional | 26 | $64.57 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $208.93 / $630.96
| Professional | TC | $125.89 | $208.93 | $630.96 |