- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $467.74
| Professional | | $112.20 | $234.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $144.54
| Professional | 26 | $30.90 | $64.57 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $162.18
| Professional | 52 | $69.18 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $251.19
| Professional | TC | $81.28 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $186.21 / $186.21
| Professional | | $51.29 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $63.10
| Facility | 26 | $51.29 | $51.29 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $281.84
| Professional | | $100.00 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $75.86
| Professional | 26 | $33.11 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $131.83 / $199.53
| Professional | TC | $66.07 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $208.93 / $302.00
| Professional | | $204.17 | $208.93 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $63.10
| Facility | 26 | $51.29 | $51.29 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $281.84
| Professional | | $144.54 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $51.29 / $67.61
| Professional | 26 | $34.67 | $51.29 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $138.04 / $165.96
| Professional | TC | $85.11 | $138.04 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $125.89 / $223.87
| Professional | | $120.23 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $87.10
| Professional | 26 | $34.67 | $36.31 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $89.13 / $190.55
| Professional | TC | $85.11 | $89.13 | $190.55 |