- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $38.02 / $61.66
| Facility | 26 | $36.31 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $138.04 / $416.87
| Professional | | $50.12 | $138.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $100.00
| Professional | 26 | $31.62 | $44.67 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $20.42 / $50.12 / $199.53
| Professional | 52 | $20.42 | $50.12 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $295.12
| Professional | TC | $79.43 | $104.71 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $295.12 / $331.13
| Professional | | $223.87 | $295.12 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $93.33
| Professional | 26 | $63.10 | $83.18 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $213.80 / $239.88
| Professional | TC | $162.18 | $213.80 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $199.53 / $338.84
| Professional | | $128.82 | $199.53 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $93.33
| Professional | 26 | $36.31 | $54.95 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $245.47
| Professional | TC | $91.20 | $144.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $239.88 / $831.76
| Professional | | $120.23 | $239.88 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $74.13 / $151.36
| Professional | 26 | $54.95 | $74.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | 52 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $602.56
| Professional | TC | $104.71 | $186.21 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $346.74
| Professional | | $107.15 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $100.00
| Professional | 26 | $40.74 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $239.88
| Professional | TC | $100.00 | $162.18 | $239.88 |