- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $114.82 / $158.49
| Facility | 26 | $37.15 | $114.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $208.93 / $478.63
| Professional | | $104.71 | $208.93 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $58.88 / $144.54
| Professional | 26 | $30.20 | $58.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $338.84
| Professional | 52 | $48.98 | $112.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $112.20 / $302.00
| Professional | TC | $72.44 | $112.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $131.83
| Professional | | $75.86 | $95.50 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $26.30 / $37.15
| Professional | 26 | $24.55 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $72.44
| Professional | TC | $61.66 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $125.89 / $151.36
| Professional | | $77.62 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $69.18
| Professional | 26 | $34.67 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $48.98 / $87.10
| Professional | TC | $43.65 | $48.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $245.47
| Professional | | $100.00 | $138.04 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $69.18
| Professional | 26 | $28.18 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $181.97
| Professional | TC | $69.18 | $95.50 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $147.91 / $147.91
| Facility | 26 | $77.62 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $776.25
| Professional | | $95.50 | $128.82 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $37.15 / $288.40
| Professional | 26 | $32.36 | $37.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | 52 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $575.44
| Professional | TC | $72.44 | $93.33 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $257.04
| Professional | | $95.50 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $89.13
| Professional | 26 | $31.62 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $213.80
| Professional | TC | $75.86 | $89.13 | $213.80 |