- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $28.84
| Facility | 26 | $25.12 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $190.55
| Professional | | $54.95 | $70.79 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $60.26
| Professional | 26 | $22.91 | $28.84 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $213.80 / $257.04
| Professional | 50 | $66.07 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $77.62
| Professional | TC | $28.84 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $51.29 / $89.13
| Professional | | $47.86 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $39.81
| Professional | 26 | $22.91 | $22.91 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $117.49
| Professional | | $67.61 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $46.77
| Professional | 26 | $29.51 | $29.51 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $177.83
| Professional | 50 | $102.33 | $102.33 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $72.44
| Professional | TC | $38.02 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.90 / $77.62
| Professional | | $30.20 | $38.90 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $33.88 / $48.98
| Facility | 26 | $7.24 | $33.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $104.71 / $416.87
| Professional | | $66.07 | $104.71 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $42.66 / $141.25
| Professional | 26 | $26.30 | $42.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $64.57 / $177.83
| Professional | TC | $37.15 | $64.57 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $32.36 / $33.11
| Professional | | $30.20 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $74.13 / $112.20
| Professional | | $54.95 | $74.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $54.95
| Professional | 26 | $25.70 | $30.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $64.57
| Professional | TC | $28.84 | $42.66 | $64.57 |