- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $7.08 / $8.13
| Facility | 26 | $5.75 | $7.08 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $208.93 / $363.08
| Facility | TC | $38.90 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $44.67 / $134.90
| Professional | | $12.88 | $44.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $12.30 / $30.20
| Professional | 26 | $6.03 | $12.30 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.20 / $117.49 / $151.36
| Professional | 50 | $18.20 | $117.49 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $33.88 / $158.49
| Professional | 52 | $26.30 | $33.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $75.86
| Professional | TC | $25.12 | $41.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $38.02 / $43.65
| Professional | | $6.76 | $38.02 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $7.08 / $8.13
| Professional | 26 | $6.31 | $7.08 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $41.69
| Professional | TC | $27.54 | $33.11 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $10.96
| Facility | 26 | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | TC | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $69.18
| Professional | | $25.12 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $7.59 / $14.13
| Professional | 26 | $5.13 | $7.59 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $61.66
| Professional | TC | $19.50 | $29.51 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $63.10
| Professional | | $38.02 | $46.77 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.76 / $10.47
| Professional | 26 | $6.92 | $7.76 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $52.48
| Professional | TC | $30.20 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $79.43
| Professional | | $21.88 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $7.59 / $15.49
| Professional | 26 | $5.25 | $7.59 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $63.10
| Professional | TC | $17.78 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $45.71 / $63.10
| Professional | | $25.12 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.27 / $7.24 / $10.23
| Professional | 26 | $4.27 | $7.24 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $52.48
| Professional | TC | $20.89 | $38.90 | $52.48 |