- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $83.18
| Facility | 26 | $42.66 | $67.61 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $239.88
| Professional | | $61.66 | $87.10 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $134.90
| Professional | 26 | $25.70 | $34.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $977.24
| Professional | 50 | $363.08 | $363.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $107.15
| Professional | TC | $33.88 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $151.36 / $234.42
| Professional | | $85.11 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $91.20
| Professional | 26 | $34.67 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $91.20 / $144.54
| Professional | TC | $52.48 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $165.96 / $199.53
| Professional | | $147.91 | $165.96 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $83.18
| Professional | 26 | $63.10 | $69.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $117.49
| Professional | TC | $85.11 | $95.50 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $83.18
| Facility | 26 | $42.66 | $67.61 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $223.87
| Professional | | $95.50 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $95.50
| Professional | 26 | $36.31 | $66.07 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $977.24
| Professional | 50 | $363.08 | $363.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $128.82
| Professional | TC | $54.95 | $91.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $70.79 / $117.49
| Professional | | $50.12 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $169.82 / $223.87
| Professional | | $125.89 | $169.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $91.20
| Professional | 26 | $44.67 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $144.54
| Professional | TC | $67.61 | $104.71 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Facility | 26 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $177.83 / $239.88
| Professional | | $141.25 | $177.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $72.44 / $95.50
| Professional | 26 | $60.26 | $72.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $104.71 / $138.04
| Professional | TC | $81.28 | $104.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $245.47
| Professional | | $81.28 | $102.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $38.02 / $91.20
| Professional | 26 | $32.36 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $64.57 / $151.36
| Professional | TC | $48.98 | $64.57 | $151.36 |