- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | 26 | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $457.09
| Facility | TC | $48.98 | $48.98 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $138.04
| Professional | | $34.67 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $20.42 / $41.69
| Professional | 26 | $11.48 | $20.42 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $75.86 / $269.15
| Professional | 50 | $29.51 | $75.86 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $87.10
| Professional | TC | $26.92 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $66.07
| Professional | | $33.88 | $42.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $11.75 / $18.20
| Professional | 26 | $10.23 | $11.75 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $34.67
| Professional | TC | $22.91 | $22.91 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $64.57
| Professional | | $34.67 | $50.12 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $14.79 / $18.62
| Professional | 26 | $10.23 | $14.79 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $35.48 / $45.71
| Professional | TC | $24.55 | $35.48 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $114.82
| Professional | | $38.02 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $36.31
| Professional | 26 | $12.02 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $95.50
| Professional | TC | $29.51 | $41.69 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $95.50
| Professional | | $38.02 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $15.14 / $38.90
| Professional | 26 | $11.75 | $15.14 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $48.98
| Professional | TC | $25.70 | $35.48 | $48.98 |