- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $346.74
| Facility | 26 | $97.72 | $131.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $426.58 / $1,412.54
| Professional | | $239.88 | $426.58 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $251.19
| Professional | 26 | $67.61 | $120.23 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $1,513.56
| Professional | 52 | $147.91 | $281.84 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $281.84 / $616.60
| Professional | TC | $169.82 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $177.83 / $316.23
| Professional | | $165.96 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $114.82
| Professional | 26 | $51.29 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Professional | TC | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $346.74 / $776.25
| Professional | | $245.47 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $83.18 / $144.54
| Professional | 26 | $72.44 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $616.60
| Professional | TC | $173.78 | $251.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $446.68
| Professional | | $234.42 | $251.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $104.71
| Professional | 26 | $72.44 | $74.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $173.78 / $354.81
| Professional | TC | $158.49 | $173.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $112.20
| Facility | 26 | $16.98 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $416.87 / $812.83
| Professional | | $208.93 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $173.78
| Professional | 26 | $60.26 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $309.03 / $691.83
| Professional | TC | $158.49 | $309.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $501.19 / $645.65 / $645.65
| Facility | 26 | $501.19 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $512.86 / $3,467.37
| Professional | | $263.03 | $512.86 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $575.44
| Professional | 26 | $64.57 | $102.33 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $398.11 / $2,454.71
| Professional | TC | $186.21 | $398.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $676.08
| Professional | | $234.42 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $85.11 / $181.97
| Professional | 26 | $66.07 | $85.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $537.03
| Professional | TC | $173.78 | $263.03 | $537.03 |