- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $204.17
| Facility | 26 | $120.23 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $295.12
| Professional | | $67.61 | $117.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $144.54
| Professional | 26 | $26.92 | $45.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $36.31 / $288.40 / $457.09
| Professional | 50 | $36.31 | $288.40 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $177.83
| Professional | TC | $51.29 | $72.44 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $331.13
| Professional | | $112.20 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $120.23
| Professional | 26 | $40.74 | $58.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $213.80
| Professional | TC | $72.44 | $114.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $436.52
| Facility | 26 | $112.20 | $151.36 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $288.40 / $446.68
| Professional | | $112.20 | $288.40 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $104.71 / $190.55
| Professional | 26 | $38.90 | $104.71 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $107.15 / $331.13 / $724.44
| Professional | 50 | $107.15 | $331.13 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $177.83 / $263.03
| Professional | TC | $81.28 | $177.83 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $426.58 / $616.60
| Professional | | $416.87 | $426.58 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $144.54 / $208.93
| Professional | 26 | $128.82 | $144.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $281.84 / $407.38
| Professional | TC | $251.19 | $281.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $199.53 / $316.23
| Professional | | $109.65 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $128.82
| Professional | 26 | $33.11 | $48.98 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $93.33 / $213.80
| Professional | TC | $66.07 | $93.33 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $263.03 / $562.34
| Professional | | $109.65 | $263.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $102.33 / $218.78
| Professional | 26 | $40.74 | $102.33 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $158.49 / $338.84
| Professional | TC | $74.13 | $158.49 | $338.84 |