- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $95.50
| Professional | | $48.98 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $25.70 / $43.65
| Professional | 26 | $18.20 | $25.70 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Professional | 50 | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $60.26
| Professional | TC | $25.70 | $34.67 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $537.03
| Facility | | $436.52 | $436.52 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $43.65 / $58.88
| Professional | | $18.62 | $43.65 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $147.91
| Professional | | $58.88 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $50.12
| Professional | 26 | $21.88 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $100.00
| Professional | TC | $33.88 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.02 / $87.10
| Professional | | $32.36 | $38.02 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $125.89
| Facility | | $51.29 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $147.91
| Professional | | $58.88 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $50.12
| Professional | 26 | $21.88 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $100.00
| Professional | TC | $33.88 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $128.82
| Professional | | $54.95 | $85.11 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $45.71
| Professional | 26 | $23.44 | $33.11 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $89.13
| Professional | TC | $30.90 | $52.48 | $89.13 |