- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $112.20 / $338.84
| Facility | 26 | $40.74 | $112.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $229.09 / $588.84
| Professional | | $112.20 | $229.09 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $151.36
| Professional | 26 | $32.36 | $44.67 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $33.88 / $89.13 / $616.60
| Professional | 52 | $33.88 | $89.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $269.15
| Professional | TC | $81.28 | $104.71 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $263.03
| Professional | | $134.90 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $75.86
| Professional | 26 | $38.90 | $48.98 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $190.55
| Professional | TC | $95.50 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $204.17
| Professional | | $32.36 | $33.11 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | 26 | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $213.80 / $269.15
| Professional | | $177.83 | $213.80 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $75.86
| Professional | 26 | $50.12 | $58.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $151.36 / $190.55
| Professional | TC | $128.82 | $151.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $288.40
| Professional | | $120.23 | $194.98 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $85.11
| Professional | 26 | $34.67 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $141.25 / $154.88
| Professional | TC | $85.11 | $141.25 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $141.25 / $223.87
| Professional | | $51.29 | $141.25 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $229.09
| Professional | | $114.82 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $66.07
| Professional | 26 | $37.15 | $43.65 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $165.96
| Professional | TC | $89.13 | $109.65 | $165.96 |