- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $63.10
| Facility | 26 | $34.67 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $190.55 / $501.19
| Professional | | $104.71 | $190.55 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $125.89
| Professional | 26 | $33.88 | $56.23 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $199.53
| Professional | 52 | $31.62 | $50.12 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $275.42
| Professional | TC | $81.28 | $112.20 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $30.20
| Facility | 26 | $25.12 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $457.09
| Professional | | $208.93 | $323.59 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $89.13 / $128.82
| Professional | 26 | $58.88 | $89.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $245.47 / $331.13
| Professional | TC | $154.88 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $316.23
| Facility | 26 | $58.88 | $128.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $251.19 / $398.11
| Professional | | $154.88 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $107.15
| Professional | 26 | $41.69 | $67.61 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $181.97 / $288.40
| Professional | TC | $112.20 | $181.97 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $123.03 / $251.19
| Facility | 26 | $102.33 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $346.74
| Professional | | $199.53 | $199.53 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $97.72
| Professional | 26 | $53.70 | $53.70 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $257.04
| Professional | TC | $144.54 | $144.54 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $380.19 / $478.63
| Professional | | $141.25 | $380.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $95.50 / $194.98
| Professional | 26 | $51.29 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $181.97 / $208.93 / $346.74
| Professional | 52 | $181.97 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $194.98 / $562.34
| Professional | TC | $102.33 | $194.98 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $234.42 / $1,047.13
| Professional | | $85.11 | $234.42 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $85.11 / $102.33
| Professional | 26 | $43.65 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $269.15
| Professional | TC | $85.11 | $95.50 | $269.15 |