- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $42.66
| Facility | 26 | $39.81 | $39.81 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $147.91 / $302.00
| Professional | | $83.18 | $147.91 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $114.82
| Professional | 26 | $34.67 | $46.77 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Professional | 50 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $85.11 / $138.04
| Professional | TC | $53.70 | $85.11 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Professional | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $223.87
| Professional | | $120.23 | $173.78 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $77.62
| Professional | 26 | $42.66 | $60.26 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $112.20 / $144.54
| Professional | TC | $79.43 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $138.04 / $331.13
| Professional | | $93.33 | $138.04 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $120.23
| Professional | 26 | $35.48 | $50.12 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $89.13 / $199.53
| Professional | TC | $53.70 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $158.49
| Professional | | $79.43 | $104.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $56.23
| Professional | 26 | $33.11 | $43.65 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $61.66 / $104.71
| Professional | TC | $46.77 | $61.66 | $104.71 |