- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $19.50 / $50.12
| Facility | 26 | $6.03 | $19.50 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $32.36 / $87.10
| Professional | | $16.22 | $32.36 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $15.14 / $36.31
| Professional | 26 | $6.03 | $15.14 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $52.48 / $138.04 / $275.42
| Professional | 50 | $52.48 | $138.04 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | 52 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $25.70 / $64.57
| Professional | TC | $15.85 | $25.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $28.84 / $100.00
| Professional | | $8.13 | $28.84 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $7.41 / $8.51
| Professional | 26 | $7.24 | $7.41 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $23.99 / $23.99
| Professional | TC | $21.38 | $23.99 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $70.79
| Professional | | $22.91 | $33.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $9.33 / $18.62
| Professional | 26 | $6.46 | $9.33 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $23.44 / $53.70
| Professional | TC | $16.60 | $23.44 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $67.61
| Professional | | $27.54 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $16.98
| Professional | 26 | $7.08 | $8.32 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $51.29
| Professional | TC | $20.89 | $24.55 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $95.50 / $181.97
| Professional | | $26.92 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $47.86 / $95.50
| Professional | 26 | $7.41 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $63.10 / $134.90
| Professional | TC | $18.62 | $63.10 | $134.90 |