- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $85.11
| Facility | 26 | $47.86 | $47.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $501.19
| Professional | | $89.13 | $138.04 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $251.19
| Professional | 26 | $41.69 | $57.54 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $323.59 / $323.59 / $346.74
| Professional | 50 | $323.59 | $323.59 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $52.48 / $120.23
| Professional | TC | $41.69 | $52.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $107.15 / $302.00
| Professional | | $95.50 | $107.15 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $56.23 / $66.07
| Professional | 26 | $52.48 | $56.23 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $151.36 / $239.88
| Professional | | $100.00 | $151.36 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $114.82
| Professional | 26 | $45.71 | $69.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $125.89
| Professional | TC | $54.95 | $75.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $147.91 / $295.12
| Professional | | $102.33 | $147.91 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $131.83
| Professional | 26 | $50.12 | $72.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $162.18
| Professional | TC | $50.12 | $79.43 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $263.03
| Professional | | $109.65 | $165.96 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $120.23
| Professional | 26 | $50.12 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $144.54
| Professional | TC | $60.26 | $89.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $165.96 / $309.03
| Professional | | $109.65 | $165.96 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $128.82
| Professional | 26 | $50.12 | $77.62 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $177.83
| Professional | TC | $60.26 | $91.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $28.18 / $36.31
| Facility | 26 | $24.55 | $28.18 | $36.31 |