- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $102.33 / $302.00
| Facility | 26 | $40.74 | $102.33 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $446.68
| Professional | | $131.83 | $208.93 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $63.10 / $125.89
| Professional | 26 | $40.74 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | 52 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $295.12
| Professional | TC | $93.33 | $114.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $162.18 / $407.38
| Professional | | $117.49 | $162.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $50.12
| Professional | 26 | $44.67 | $44.67 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $117.49 / $154.88
| Professional | TC | $114.82 | $117.49 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $204.17 / $426.58
| Professional | | $131.83 | $204.17 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $117.49
| Professional | 26 | $39.81 | $56.23 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $302.00
| Professional | TC | $95.50 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $181.97 / $371.54
| Professional | | $154.88 | $181.97 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $50.12 / $104.71
| Professional | 26 | $42.66 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $269.15
| Professional | TC | $109.65 | $128.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $154.88 / $676.08
| Professional | | $95.50 | $154.88 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $95.50 / $281.84
| Professional | 26 | $44.67 | $95.50 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $676.08
| Professional | TC | $95.50 | $131.83 | $676.08 |