- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $691.83
| Facility | 26 | $44.67 | $56.23 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $436.52
| Professional | | $87.10 | $151.36 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $120.23
| Professional | 26 | $40.74 | $64.57 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $70.79 / $79.43 / $93.33
| Professional | 52 | $70.79 | $79.43 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $74.13 / $162.18
| Professional | TC | $40.74 | $74.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $91.20 / $97.72
| Professional | | $89.13 | $91.20 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $42.66 / $50.12
| Professional | 26 | $39.81 | $42.66 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | TC | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $158.49 / $245.47
| Professional | | $97.72 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $57.54 / $87.10
| Professional | 26 | $43.65 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $102.33 / $151.36
| Professional | TC | $53.70 | $102.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $204.17 / $398.11
| Professional | | $123.03 | $204.17 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $151.36
| Professional | 26 | $52.48 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $114.82 / $190.55
| Professional | TC | $63.10 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $257.04
| Professional | | $107.15 | $162.18 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $104.71
| Professional | 26 | $42.66 | $61.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $154.88
| Professional | TC | $61.66 | $97.72 | $154.88 |