- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $40.74 / $45.71
| Facility | 26 | $15.85 | $40.74 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $295.12
| Professional | | $46.77 | $66.07 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $81.28
| Professional | 26 | $16.98 | $34.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | 50 | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $72.44
| Professional | TC | $36.31 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $57.54 / $69.18
| Professional | | $15.49 | $57.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $16.60 / $18.20
| Professional | 26 | $15.14 | $16.60 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $46.77 / $56.23
| Professional | TC | $42.66 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $245.47
| Professional | | $56.23 | $87.10 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $27.54 / $72.44
| Professional | 26 | $16.60 | $27.54 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $173.78
| Professional | TC | $38.90 | $61.66 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $144.54
| Professional | | $70.79 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $22.39 / $40.74
| Professional | 26 | $19.05 | $22.39 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $104.71
| Professional | TC | $51.29 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $177.83
| Professional | | $56.23 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $29.51 / $50.12
| Professional | 26 | $16.60 | $29.51 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $134.90
| Professional | TC | $38.90 | $70.79 | $134.90 |