- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $79.43 / $169.82
| Facility | 26 | $51.29 | $79.43 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $302.00
| Professional | | $87.10 | $131.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $162.18
| Professional | 26 | $41.69 | $63.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $10.23 / $93.33 / $186.21
| Professional | 52 | $10.23 | $93.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $158.49
| Professional | TC | $43.65 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $141.25 / $229.09
| Professional | | $89.13 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $61.66 / $91.20
| Professional | 26 | $43.65 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $138.04
| Professional | TC | $46.77 | $72.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $323.59
| Professional | | $112.20 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $125.89
| Professional | 26 | $50.12 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $194.98
| Professional | TC | $61.66 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $169.82 / $512.86
| Professional | | $107.15 | $169.82 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $208.93
| Professional | 26 | $45.71 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $97.72 / $309.03
| Professional | TC | $61.66 | $97.72 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $107.15 / $147.91
| Professional | | $95.50 | $107.15 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $45.71 / $69.18
| Professional | 26 | $42.66 | $45.71 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $79.43
| Professional | TC | $51.29 | $61.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $316.23
| Professional | | $125.89 | $181.97 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $125.89
| Professional | 26 | $53.70 | $81.28 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $100.00 / $190.55
| Professional | TC | $52.48 | $100.00 | $190.55 |