- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $61.66 / $97.72
| Facility | 26 | $47.86 | $61.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $457.09
| Professional | | $120.23 | $181.97 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $138.04
| Professional | 26 | $41.69 | $63.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | 52 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $251.19
| Professional | TC | $93.33 | $120.23 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $316.23
| Professional | | $144.54 | $213.80 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $91.20
| Professional | 26 | $42.66 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $223.87
| Professional | TC | $100.00 | $151.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $213.80 / $363.08
| Professional | | $144.54 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $107.15
| Professional | 26 | $42.66 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $257.04
| Professional | TC | $102.33 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $933.25
| Professional | | $234.42 | $257.04 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $74.13
| Professional | 26 | $67.61 | $67.61 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $181.97
| Professional | TC | $165.96 | $165.96 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $165.96 / $245.47
| Professional | | $151.36 | $165.96 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $46.77 / $74.13
| Professional | 26 | $45.71 | $46.77 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $169.82
| Professional | TC | $104.71 | $117.49 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $234.42 / $354.81
| Professional | | $169.82 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $131.83
| Professional | 26 | $51.29 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $263.03
| Professional | TC | $114.82 | $162.18 | $263.03 |