- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $75.86
| Facility | 26 | $32.36 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $194.98 / $478.63
| Professional | | $100.00 | $194.98 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $134.90
| Professional | 26 | $28.84 | $56.23 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $60.26 / $134.90 / $354.81
| Professional | 52 | $60.26 | $134.90 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $363.08
| Professional | TC | $70.79 | $112.20 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $194.98
| Professional | | $70.79 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $26.30 / $47.86
| Professional | 26 | $24.55 | $26.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $144.54
| Professional | TC | $61.66 | $61.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $218.78
| Professional | | $109.65 | $134.90 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $67.61
| Professional | 26 | $34.67 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $154.88
| Professional | TC | $75.86 | $85.11 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $128.82 / $173.78
| Professional | | $120.23 | $128.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $38.02 / $54.95
| Professional | 26 | $35.48 | $38.02 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $91.20 / $123.03
| Professional | TC | $85.11 | $91.20 | $123.03 |
- 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
- $93.33 / $134.90 / $275.42
| Professional | | $93.33 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $87.10
| Professional | 26 | $28.84 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $213.80
| Professional | TC | $66.07 | $97.72 | $213.80 |
- 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
- $107.15 / $147.91 / $776.25
| Professional | | $107.15 | $147.91 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $288.40
| Professional | 26 | $32.36 | $44.67 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $575.44
| Professional | TC | $74.13 | $107.15 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $128.82 / $251.19
| Professional | | $93.33 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $39.81 / $89.13
| Professional | 26 | $31.62 | $39.81 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $177.83
| Professional | TC | $70.79 | $93.33 | $177.83 |