- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $109.65 / $281.84
| Facility | 26 | $67.61 | $109.65 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $371.54 / $1,258.93
| Professional | | $117.49 | $371.54 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $125.89 / $316.23
| Professional | 26 | $63.10 | $125.89 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $288.40 / $1,230.27 / $1,905.46
| Professional | 50 | $288.40 | $1,230.27 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $107.15 / $407.38 / $1,047.13
| Professional | 52 | $107.15 | $407.38 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $281.84 / $616.60
| Professional | TC | $144.54 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $380.19 / $776.25
| Professional | | $204.17 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $158.49
| Professional | 26 | $63.10 | $85.11 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $1,071.52
| Professional | 50 | $316.23 | $489.78 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $281.84 / $645.65
| Professional | TC | $147.91 | $281.84 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $83.18 / $223.87
| Facility | 26 | $15.49 | $83.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $407.38 / $794.33
| Professional | | $194.98 | $407.38 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $181.97
| Professional | 26 | $52.48 | $91.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $758.58
| Professional | 50 | $302.00 | $346.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $295.12 / $630.96
| Professional | TC | $138.04 | $295.12 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $338.84 / $977.24
| Professional | | $190.55 | $338.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $85.11 / $323.59
| Professional | 26 | $56.23 | $85.11 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $234.42 / $724.44
| Professional | TC | $131.83 | $234.42 | $724.44 |