- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $89.13 / $104.71
| Facility | 26 | $25.70 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $398.11
| Professional | | $53.70 | $87.10 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $104.71
| Professional | 26 | $16.22 | $25.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.84 / $263.03 / $263.03
| Professional | 50 | $28.84 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $44.67 / $91.20
| Professional | TC | $36.31 | $44.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $125.89
| Professional | | $50.12 | $74.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $22.91 / $37.15
| Professional | 26 | $16.22 | $22.91 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $89.13
| Professional | TC | $33.11 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $194.98
| Professional | | $66.07 | $97.72 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $28.84 / $53.70
| Professional | 26 | $19.50 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $138.04
| Professional | TC | $44.67 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $91.20 / $128.82
| Professional | | $70.79 | $91.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $36.31
| Professional | 26 | $20.89 | $25.70 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $93.33
| Professional | TC | $48.98 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.11 / $190.55
| Professional | | $30.90 | $33.11 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $181.97
| Professional | | $54.95 | $87.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $26.30 / $51.29
| Professional | 26 | $16.60 | $26.30 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $131.83
| Professional | TC | $39.81 | $61.66 | $131.83 |