- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $56.23 / $128.82
| Facility | 26 | $26.92 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $275.42
| Professional | | $61.66 | $87.10 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $120.23
| Professional | 26 | $25.70 | $33.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $144.54 / $263.03 / $741.31
| Professional | 50 | $144.54 | $263.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $112.20
| Professional | TC | $33.88 | $47.86 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $199.53 / $199.53
| Facility | 26 | $75.86 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $602.56
| Professional | | $66.07 | $120.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $346.74
| Professional | 26 | $28.18 | $45.71 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $77.62 / $363.08
| Professional | TC | $41.69 | $77.62 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $239.88
| Professional | | $63.10 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $46.77 / $93.33
| Professional | 26 | $26.30 | $46.77 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $144.54
| Professional | TC | $38.90 | $79.43 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $69.18 / $134.90
| Professional | | $39.81 | $69.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $213.80
| Professional | | $79.43 | $128.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $51.29 / $85.11
| Professional | 26 | $33.11 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $77.62 / $117.49
| Professional | TC | $45.71 | $77.62 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $199.53 / $199.53
| Facility | 26 | $75.86 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $602.56
| Professional | | $66.07 | $120.23 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $346.74
| Professional | 26 | $28.18 | $45.71 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $77.62 / $363.08
| Professional | TC | $41.69 | $77.62 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $229.09
| Professional | | $81.28 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $91.20
| Professional | 26 | $32.36 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $131.83
| Professional | TC | $50.12 | $77.62 | $131.83 |