- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $10.00 / $23.99
| Professional | 26 | $8.32 | $10.00 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $63.10
| Professional | TC | $20.89 | $23.99 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $19.95 / $21.38
| Professional | 26 | $19.05 | $19.95 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $50.12
| Professional | TC | $43.65 | $47.86 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $23.44 / $30.90
| Professional | 26 | $12.30 | $23.44 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $56.23 / $81.28
| Professional | TC | $26.92 | $56.23 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $17.38 / $77.62
| Professional | 26 | $12.30 | $17.38 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $302.00
| Professional | TC | $27.54 | $40.74 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $23.44 / $36.31
| Professional | 26 | $20.89 | $23.44 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $57.54 / $91.20
| Professional | TC | $50.12 | $57.54 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $19.95 / $36.31
| Professional | 26 | $16.98 | $19.95 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $91.20
| Professional | TC | $41.69 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.38 / $26.30
| Professional | 26 | $11.75 | $17.38 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $61.66
| Professional | TC | $26.30 | $40.74 | $61.66 |