- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $45.71
| Facility | 26 | $33.11 | $39.81 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $144.54 / $501.19
| Professional | | $63.10 | $144.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $61.66 / $112.20
| Professional | 26 | $33.88 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $602.56
| Professional | 52 | $95.50 | $95.50 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $107.15 / $257.04
| Professional | TC | $74.13 | $107.15 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $128.82 / $154.88
| Professional | | $40.74 | $128.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $45.71
| Professional | 26 | $33.88 | $36.31 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $100.00 / $114.82
| Professional | TC | $89.13 | $100.00 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | 26 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $147.91 / $257.04
| Professional | | $100.00 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $79.43
| Professional | 26 | $28.84 | $43.65 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $190.55
| Professional | TC | $70.79 | $107.15 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $144.54 / $199.53
| Professional | | $131.83 | $144.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $42.66 / $58.88
| Professional | 26 | $38.90 | $42.66 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $104.71 / $141.25
| Professional | TC | $91.20 | $104.71 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $151.36 / $263.03
| Professional | | $109.65 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $85.11
| Professional | 26 | $30.90 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $186.21
| Professional | TC | $79.43 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $141.25 / $204.17
| Professional | | $104.71 | $141.25 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $40.74 / $57.54
| Professional | 26 | $31.62 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $147.91
| Professional | TC | $74.13 | $102.33 | $147.91 |