- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $48.98 / $75.86
| Facility | 26 | $47.86 | $48.98 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $151.36 / $501.19
| Professional | | $85.11 | $151.36 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $79.43 / $208.93
| Professional | 26 | $41.69 | $79.43 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $181.97 / $389.05 / $575.44
| Professional | 50 | $181.97 | $389.05 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $53.70 / $89.13
| Professional | TC | $39.81 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $123.03 / $194.98
| Professional | | $85.11 | $123.03 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $54.95 / $89.13
| Professional | 26 | $40.74 | $54.95 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $107.15
| Professional | TC | $40.74 | $66.07 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $194.98
| Professional | | $100.00 | $138.04 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $95.50
| Professional | 26 | $48.98 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $104.71
| Professional | TC | $47.86 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $162.18 / $407.38
| Professional | | $104.71 | $162.18 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $72.44 / $218.78
| Professional | 26 | $46.77 | $72.44 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $186.21
| Professional | TC | $57.54 | $91.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $104.71 / $151.36
| Professional | | $93.33 | $104.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $46.77 / $70.79
| Professional | 26 | $43.65 | $46.77 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $57.54 / $77.62
| Professional | TC | $50.12 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $213.80
| Professional | | $97.72 | $138.04 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $117.49
| Professional | 26 | $50.12 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $112.20
| Professional | TC | $46.77 | $64.57 | $112.20 |