- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $257.04
| Facility | 26 | $89.13 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $213.80
| Professional | | $61.66 | $81.28 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $67.61
| Professional | 26 | $25.70 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $173.78 / $204.17 / $407.38
| Professional | 50 | $173.78 | $204.17 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $104.71
| Professional | TC | $33.88 | $46.77 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $316.23
| Professional | | $288.40 | $288.40 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $194.98
| Professional | | $67.61 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $70.79
| Professional | 26 | $26.30 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $123.03
| Professional | TC | $38.90 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $147.91
| Professional | | $79.43 | $104.71 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $60.26
| Professional | 26 | $33.11 | $43.65 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $60.26 / $87.10
| Professional | TC | $45.71 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $117.49 / $204.17
| Professional | | $91.20 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $74.13
| Professional | 26 | $29.51 | $39.81 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $125.89
| Professional | TC | $56.23 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $100.00 / $173.78
| Professional | | $60.26 | $100.00 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $67.61
| Professional | 26 | $24.55 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $114.82
| Professional | TC | $36.31 | $63.10 | $114.82 |