- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $97.72 / $208.93
| Facility | 26 | $28.84 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $323.59
| Professional | | $100.00 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $64.57 / $104.71
| Professional | 26 | $28.84 | $64.57 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $173.78
| Professional | 52 | $56.23 | $74.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $263.03
| Professional | TC | $70.79 | $100.00 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $131.83 / $363.08
| Professional | | $89.13 | $131.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $33.11 / $36.31
| Professional | 26 | $31.62 | $33.11 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $97.72 / $102.33
| Professional | TC | $89.13 | $97.72 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $138.04 / $275.42
| Professional | | $95.50 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $75.86
| Professional | 26 | $25.70 | $38.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $204.17
| Professional | TC | $66.07 | $97.72 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $281.84
| Professional | | $114.82 | $134.90 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $72.44
| Professional | 26 | $30.20 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $100.00 / $208.93
| Professional | TC | $85.11 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $467.74
| Professional | | $95.50 | $151.36 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $95.50 / $204.17
| Professional | 26 | $30.20 | $95.50 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $281.84
| Professional | TC | $75.86 | $131.83 | $281.84 |