- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $75.86
| Facility | 26 | $60.26 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $501.19
| Professional | | $112.20 | $186.21 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $53.70 / $151.36
| Professional | 26 | $44.67 | $53.70 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | 52 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $120.23 / $331.13
| Professional | TC | $72.44 | $120.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $154.88
| Professional | | $58.88 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $47.86 / $70.79
| Professional | 26 | $38.90 | $47.86 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $54.95 / $79.43
| Professional | TC | $23.44 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $199.53 / $281.84
| Professional | | $165.96 | $199.53 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $91.20
| Professional | 26 | $56.23 | $70.79 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $194.98
| Professional | TC | $109.65 | $128.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $48.98 / $72.44
| Professional | 26 | $47.86 | $48.98 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $186.21 / $346.74
| Professional | | $97.72 | $186.21 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $60.26 / $104.71
| Professional | 26 | $36.31 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $112.20 / $269.15
| Professional | TC | $57.54 | $112.20 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $346.74
| Professional | | $131.83 | $177.83 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $89.13
| Professional | 26 | $39.81 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $112.20 / $213.80
| Professional | TC | $85.11 | $112.20 | $213.80 |