- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $147.91
| Facility | 26 | $117.49 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $234.42 / $537.03
| Professional | | $125.89 | $234.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $169.82
| Professional | 26 | $33.88 | $64.57 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $34.67 / $60.26 / $724.44
| Professional | 52 | $34.67 | $60.26 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $134.90 / $269.15
| Professional | TC | $89.13 | $134.90 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $204.17 / $204.17
| Professional | | $56.23 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $69.18
| Facility | 26 | $56.23 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $194.98 / $316.23
| Professional | | $109.65 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $53.70 / $93.33
| Professional | 26 | $29.51 | $53.70 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $144.54 / $223.87
| Professional | TC | $81.28 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $223.87 / $245.47
| Professional | | $165.96 | $223.87 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $69.18
| Facility | 26 | $56.23 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $275.42 / $346.74
| Professional | | $177.83 | $275.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $83.18
| Professional | 26 | $37.15 | $56.23 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $213.80
| Professional | TC | $97.72 | $144.54 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $154.88 / $245.47
| Professional | | $151.36 | $154.88 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $43.65 / $85.11
| Professional | 26 | $41.69 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $112.20 / $177.83
| Professional | TC | $104.71 | $112.20 | $177.83 |