- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $38.90
| Facility | 26 | $28.84 | $34.67 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $204.17 / $457.09
| Professional | | $100.00 | $204.17 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $61.66 / $128.82
| Professional | 26 | $29.51 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $354.81
| Professional | 52 | $56.23 | $74.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $302.00
| Professional | TC | $72.44 | $104.71 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $120.23 / $144.54
| Professional | | $89.13 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $33.11 / $37.15
| Professional | 26 | $30.90 | $33.11 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $95.50 / $109.65
| Professional | TC | $87.10 | $95.50 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Facility | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $229.09
| Professional | | $87.10 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $69.18
| Professional | 26 | $24.55 | $38.02 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $87.10 / $169.82
| Professional | TC | $63.10 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $144.54 / $204.17
| Professional | | $125.89 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $57.54
| Professional | 26 | $33.11 | $38.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $104.71 / $147.91
| Professional | TC | $87.10 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $281.84
| Professional | | $87.10 | $125.89 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $79.43
| Professional | 26 | $26.30 | $37.15 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $208.93
| Professional | TC | $60.26 | $91.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $154.88 / $181.97
| Professional | | $97.72 | $154.88 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $48.98
| Professional | 26 | $26.30 | $40.74 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $134.90
| Professional | TC | $70.79 | $114.82 | $134.90 |