- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $69.18 / $173.78
| Facility | 26 | $23.99 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $251.19
| Professional | | $48.98 | $79.43 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $97.72
| Professional | 26 | $22.91 | $43.65 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $46.77 / $89.13 / $229.09
| Professional | 52 | $46.77 | $89.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $43.65 / $100.00
| Professional | TC | $25.12 | $43.65 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $60.26 / $288.40
| Professional | | $32.36 | $60.26 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $27.54 / $28.84
| Professional | 26 | $25.70 | $27.54 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $38.90
| Professional | TC | $33.88 | $35.48 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $89.13 / $165.96
| Professional | | $47.86 | $89.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $60.26
| Professional | 26 | $21.38 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $58.88 / $114.82
| Professional | TC | $25.12 | $58.88 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $69.18 / $131.83
| Professional | | $58.88 | $69.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $58.88
| Professional | 26 | $25.70 | $30.20 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $74.13
| Professional | TC | $33.11 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $524.81
| Professional | | $69.18 | $95.50 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $66.07 / $162.18
| Professional | 26 | $23.99 | $66.07 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $109.65
| Professional | TC | $38.90 | $56.23 | $109.65 |