- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $190.55 / $269.15
| Facility | 26 | $57.54 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $186.21 / $562.34
| Professional | | $125.89 | $186.21 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $54.95 / $141.25
| Professional | 26 | $40.74 | $54.95 | $141.25 |
- 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
- $95.50 / $125.89 / $380.19
| Professional | TC | $95.50 | $125.89 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $223.87 / $363.08
| Professional | | $128.82 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $97.72
| Professional | 26 | $36.31 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $162.18 / $257.04
| Professional | TC | $91.20 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $251.19 / $426.58
| Professional | | $177.83 | $251.19 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $117.49
| Professional | 26 | $48.98 | $69.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $316.23
| Professional | TC | $128.82 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $223.87 / $389.05
| Professional | | $173.78 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $144.54 / $177.83
| Professional | 26 | $52.48 | $144.54 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $199.53 / $223.87
| Professional | TC | $131.83 | $199.53 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $338.84
| Professional | | $66.07 | $97.72 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $416.87
| Professional | | $144.54 | $208.93 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $60.26 / $131.83
| Professional | 26 | $41.69 | $60.26 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $323.59
| Professional | TC | $100.00 | $151.36 | $323.59 |