- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $165.96 / $537.03
| Facility | 26 | $93.33 | $165.96 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $426.58 / $1,202.26
| Professional | | $208.93 | $426.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $199.53
| Professional | 26 | $66.07 | $104.71 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $562.34 / $562.34
| Professional | 52 | $199.53 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $229.09 / $575.44
| Professional | TC | $114.82 | $229.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $154.88 / $229.09
| Professional | | $141.25 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $57.54 / $123.03
| Professional | 26 | $52.48 | $57.54 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $91.20 / $144.54
| Professional | TC | $77.62 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $478.63 / $912.01
| Professional | | $263.03 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $870.96
| Professional | 26 | $83.18 | $83.18 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | 26 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $398.11 / $758.58
| Professional | | $165.96 | $398.11 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $91.20 / $158.49
| Professional | 26 | $51.29 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $281.84 / $645.65
| Professional | TC | $107.15 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $323.59
| Professional | | $194.98 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $112.20
| Professional | 26 | $67.61 | $93.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $213.80
| Professional | TC | $128.82 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $426.58
| Professional | | $186.21 | $218.78 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $70.79 / $117.49
| Professional | 26 | $60.26 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $288.40
| Professional | TC | $125.89 | $151.36 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $660.69
| Professional | | $165.96 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $151.36
| Professional | 26 | $56.23 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $190.55 / $489.78
| Professional | TC | $109.65 | $190.55 | $489.78 |