- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $12.59 / $26.92
| Facility | 26 | $10.47 | $12.59 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $380.19
| Facility | TC | $39.81 | $57.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $52.48 / $131.83
| Professional | | $15.49 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $21.88 / $56.23
| Professional | 26 | $8.91 | $21.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $45.71 / $141.25 / $416.87
| Professional | 50 | $45.71 | $141.25 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $87.10
| Professional | TC | $28.18 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $81.28
| Professional | | $32.36 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.88 / $21.88
| Professional | 26 | $7.59 | $12.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $60.26
| Professional | TC | $23.99 | $33.11 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | TC | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $20.89 / $158.49
| Professional | 26 | $12.30 | $20.89 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.88
| Professional | TC | $33.11 | $33.11 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $69.18 / $239.88
| Professional | | $36.31 | $69.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $17.78 / $79.43
| Professional | 26 | $8.91 | $17.78 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $72.44
| Professional | TC | $24.55 | $33.11 | $72.44 |