- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $151.36
| Facility | 26 | $28.84 | $47.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $389.05
| Professional | | $100.00 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $128.82
| Professional | 26 | $28.84 | $54.95 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $354.81
| Professional | 52 | $60.26 | $102.33 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $245.47
| Professional | TC | $70.79 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $199.53
| Professional | | $87.10 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $60.26
| Professional | 26 | $25.12 | $41.69 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | 52 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $144.54
| Professional | TC | $61.66 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $229.09
| Professional | | $102.33 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $75.86
| Professional | 26 | $32.36 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $165.96
| Professional | TC | $64.57 | $97.72 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $83.18 / $134.90
| Professional | | $32.36 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $269.15
| Professional | | $102.33 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $83.18
| Professional | 26 | $30.90 | $46.77 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $199.53
| Professional | TC | $66.07 | $114.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $138.04 / $371.54
| Professional | | $120.23 | $138.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $117.49
| Professional | 26 | $33.11 | $39.81 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $147.91
| Professional | 52 | $104.71 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $302.00
| Professional | TC | $87.10 | $100.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $117.49 / $186.21
| Professional | | $45.71 | $117.49 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $263.03
| Professional | | $107.15 | $138.04 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $42.66 / $79.43
| Professional | 26 | $31.62 | $42.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $100.00 / $190.55
| Professional | TC | $75.86 | $100.00 | $190.55 |