- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $120.23
| Facility | 26 | $70.79 | $70.79 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $436.52 / $1,148.15
| Professional | | $239.88 | $436.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $125.89 / $251.19
| Professional | 26 | $69.18 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $1,513.56 / $2,187.76
| Professional | 52 | $147.91 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $562.34
| Professional | TC | $169.82 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $57.54
| Facility | 26 | $47.86 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $575.44 / $831.76
| Professional | | $380.19 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $245.47
| Professional | 26 | $112.20 | $173.78 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $436.52 / $588.84
| Professional | TC | $275.42 | $436.52 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $245.47 / $602.56
| Facility | 26 | $112.20 | $245.47 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $446.68 / $954.99
| Professional | | $354.81 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $213.80
| Professional | 26 | $79.43 | $128.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $724.44
| Professional | TC | $251.19 | $323.59 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $478.63
| Facility | 26 | $194.98 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $812.83
| Professional | | $354.81 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $186.21
| Professional | 26 | $102.33 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $691.83
| Professional | TC | $251.19 | $251.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $645.65
| Facility | 26 | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $676.08 / $3,467.37
| Professional | | $295.12 | $676.08 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $147.91 / $575.44
| Professional | 26 | $75.86 | $147.91 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $239.88 / $380.19 / $1,348.96
| Professional | 52 | $239.88 | $380.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $478.63 / $2,454.71
| Professional | TC | $194.98 | $478.63 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $239.88 / $776.25
| Professional | | $85.11 | $239.88 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $562.34
| Professional | 26 | $85.11 | $141.25 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $660.69
| Professional | TC | $194.98 | $407.38 | $660.69 |