- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $46.77 / $123.03
| Facility | 26 | $22.91 | $46.77 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $208.93
| Professional | | $54.95 | $77.62 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $83.18
| Professional | 26 | $22.91 | $33.11 | $83.18 |
- 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
- $26.92 / $42.66 / $100.00
| Professional | TC | $26.92 | $42.66 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $190.55 / $190.55
| Facility | 26 | $70.79 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $93.33 / $501.19
| Professional | | $54.95 | $93.33 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $331.13
| Professional | 26 | $25.12 | $39.81 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $331.13
| Professional | TC | $32.36 | $53.70 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $102.33 / $199.53
| Professional | | $58.88 | $102.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $43.65 / $83.18
| Professional | 26 | $23.99 | $43.65 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $120.23
| Professional | TC | $35.48 | $63.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $123.03
| Professional | | $35.48 | $61.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $190.55
| Professional | | $70.79 | $109.65 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $79.43
| Professional | 26 | $30.90 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $64.57 / $104.71
| Professional | TC | $40.74 | $64.57 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $190.55 / $190.55
| Facility | 26 | $70.79 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $93.33 / $501.19
| Professional | | $54.95 | $93.33 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $331.13
| Professional | 26 | $25.12 | $39.81 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $331.13
| Professional | TC | $32.36 | $53.70 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $208.93
| Professional | | $66.07 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $87.10
| Professional | 26 | $26.92 | $41.69 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $114.82
| Professional | TC | $36.31 | $57.54 | $114.82 |