- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $64.57 / $151.36
| Facility | 26 | $60.26 | $64.57 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $302.00 / $537.03
| Professional | | $169.82 | $302.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $316.23
| Professional | 26 | $60.26 | $102.33 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,698.24 / $1,819.70 / $2,951.21
| Professional | 50 | $1,698.24 | $1,819.70 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $218.78 / $380.19
| Professional | TC | $158.49 | $218.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $83.18
| Professional | 26 | $70.79 | $70.79 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $549.54
| Professional | | $323.59 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $158.49
| Professional | 26 | $97.72 | $125.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $389.05
| Professional | TC | $229.09 | $269.15 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $85.11 / $87.10
| Professional | 26 | $39.81 | $85.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $724.44
| Professional | | $229.09 | $346.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $181.97
| Professional | 26 | $63.10 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $257.04 / $549.54
| Professional | TC | $162.18 | $257.04 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $676.08
| Professional | | $275.42 | $389.05 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $95.50 / $147.91
| Professional | 26 | $72.44 | $95.50 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $512.86
| Professional | TC | $199.53 | $281.84 | $512.86 |