- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $190.55 / $263.03
| Professional | | $114.82 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $75.86 / $100.00
| Professional | 26 | $33.11 | $75.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $35.48 / $147.91 / $154.88
| Professional | 52 | $35.48 | $147.91 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $213.80
| Professional | TC | $81.28 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $194.98 / $549.54
| Professional | | $165.96 | $194.98 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $151.36
| Professional | 26 | $46.77 | $54.95 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $141.25
| Professional | TC | $120.23 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $190.55 / $407.38
| Professional | | $177.83 | $190.55 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $52.48 / $109.65
| Professional | 26 | $48.98 | $52.48 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $138.04 / $281.84
| Professional | TC | $114.82 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | 26 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | TC | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $354.81
| Professional | | $131.83 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $93.33
| Professional | 26 | $37.15 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $125.89 / $263.03
| Professional | TC | $95.50 | $125.89 | $263.03 |