- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $134.90 / $186.21
| Facility | 26 | $39.81 | $134.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $138.04 / $416.87
| Professional | | $57.54 | $138.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $53.70 / $125.89
| Professional | 26 | $33.11 | $53.70 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 52 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $97.72 / $257.04
| Professional | TC | $72.44 | $97.72 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $100.00
| Professional | | $81.28 | $95.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $37.15
| Professional | 26 | $28.18 | $30.90 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $72.44
| Professional | TC | $61.66 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $199.53
| Professional | | $100.00 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $53.70
| Professional | 26 | $26.92 | $33.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $87.10 / $354.81
| Professional | TC | $72.44 | $87.10 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $43.65 / $61.66
| Facility | 26 | $9.33 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $154.88 / $269.15
| Professional | | $104.71 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $85.11
| Professional | 26 | $31.62 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $194.98
| Professional | TC | $72.44 | $107.15 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $173.78 / $173.78
| Facility | 26 | $91.20 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $812.83
| Professional | | $134.90 | $158.49 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $46.77 / $239.88
| Professional | 26 | $40.74 | $46.77 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $562.34
| Professional | TC | $93.33 | $109.65 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $245.47
| Professional | | $107.15 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $95.50
| Professional | 26 | $39.81 | $46.77 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $104.71 / $190.55
| Professional | TC | $91.20 | $104.71 | $190.55 |