- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $58.88
| Facility | 26 | $31.62 | $33.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $181.97 / $478.63
| Professional | | $100.00 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $128.82
| Professional | 26 | $29.51 | $54.95 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $128.82 / $281.84
| Professional | 52 | $60.26 | $128.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $186.21
| Professional | TC | $70.79 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $97.72 / $151.36
| Professional | | $74.13 | $97.72 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $42.66
| Professional | 26 | $19.95 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | 52 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $102.33
| Professional | TC | $46.77 | $83.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $173.78
| Professional | | $69.18 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $35.48 / $56.23
| Professional | 26 | $32.36 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $112.20
| Professional | TC | $37.15 | $58.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $79.43 / $134.90
| Professional | | $33.11 | $79.43 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $37.15 / $53.70
| Facility | 26 | $7.94 | $37.15 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $549.54
| Professional | | $95.50 | $158.49 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $162.18
| Professional | 26 | $30.90 | $48.98 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $114.82 / $398.11
| Professional | TC | $61.66 | $114.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $74.13
| Professional | | $32.36 | $33.11 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $208.93
| Professional | | $91.20 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $67.61
| Professional | 26 | $30.20 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $147.91
| Professional | TC | $58.88 | $85.11 | $147.91 |