- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $117.49 / $562.34
| Facility | 26 | $57.54 | $117.49 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $144.54 / $380.19
| Professional | | $87.10 | $144.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $69.18 / $208.93
| Professional | 26 | $41.69 | $69.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $44.67 / $93.33 / $630.96
| Professional | 52 | $44.67 | $93.33 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $85.11 / $199.53
| Professional | TC | $43.65 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $100.00
| Professional | | $95.50 | $95.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $56.23 / $66.07
| Professional | 26 | $40.74 | $56.23 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | 52 | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $52.48
| Professional | TC | $46.77 | $46.77 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $281.84 / $588.84
| Professional | | $107.15 | $281.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $117.49
| Professional | 26 | $38.90 | $38.90 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | 26 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $218.78 / $398.11
| Professional | | $72.44 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $83.18 / $147.91
| Professional | 26 | $33.11 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $138.04 / $263.03
| Professional | TC | $40.74 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $208.93
| Professional | | $104.71 | $158.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $89.13
| Professional | 26 | $44.67 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $120.23
| Professional | TC | $60.26 | $93.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $123.03 / $371.54
| Professional | | $95.50 | $123.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $44.67 / $138.04
| Professional | 26 | $35.48 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $74.13 / $245.47
| Professional | TC | $61.66 | $74.13 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $316.23
| Professional | | $77.62 | $147.91 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $120.23
| Professional | 26 | $33.11 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $91.20 / $190.55
| Professional | TC | $44.67 | $91.20 | $190.55 |