- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $52.48
| Facility | 26 | $14.79 | $17.78 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $416.87
| Professional | | $72.44 | $95.50 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $28.84
| Professional | 26 | $10.00 | $12.59 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | 52 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $144.54
| Professional | TC | $61.66 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $56.23 / $95.50
| Professional | | $8.51 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $177.83
| Professional | | $85.11 | $134.90 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $16.60 / $22.39
| Professional | 26 | $11.75 | $16.60 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $158.49
| Professional | TC | $74.13 | $117.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $114.82
| Professional | | $20.42 | $33.11 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $190.55
| Professional | | $91.20 | $154.88 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $16.98 / $22.39
| Professional | 26 | $11.75 | $16.98 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $117.49 / $158.49
| Professional | TC | $74.13 | $117.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $218.78
| Professional | | $87.10 | $151.36 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $18.62 / $31.62
| Professional | 26 | $12.88 | $18.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $128.82 / $186.21
| Professional | TC | $74.13 | $128.82 | $186.21 |