- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $218.78
| Facility | 26 | $144.54 | $208.93 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $426.58 / $851.14
| Professional | | $354.81 | $426.58 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $107.15
| Professional | 26 | $52.48 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $28.18 / $95.50 / $95.50
| Professional | 52 | $28.18 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $363.08 / $676.08
| Professional | TC | $302.00 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $398.11 / $758.58
| Professional | | $331.13 | $398.11 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $56.23 / $104.71
| Professional | 26 | $45.71 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $346.74 / $645.65
| Professional | TC | $281.84 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $66.07 / $95.50
| Facility | 26 | $14.13 | $66.07 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $575.44 / $954.99
| Professional | | $398.11 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $147.91
| Professional | 26 | $57.54 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $812.83
| Professional | TC | $338.84 | $489.78 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $489.78 / $489.78
| Facility | 26 | $138.04 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $602.56 / $2,884.03
| Professional | | $398.11 | $602.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $870.96
| Professional | 26 | $54.95 | $89.13 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $2,511.89
| Professional | TC | $331.13 | $512.86 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $501.19 / $831.76
| Professional | | $363.08 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $74.13 / $125.89
| Professional | 26 | $53.70 | $74.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $426.58 / $707.95
| Professional | TC | $309.03 | $426.58 | $707.95 |