- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $14.79 / $33.11
| Facility | 26 | $12.88 | $14.79 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $478.63
| Facility | TC | $30.90 | $40.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $112.20
| Professional | | $36.31 | $48.98 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $19.05 / $41.69
| Professional | 26 | $10.96 | $19.05 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $53.70
| Professional | TC | $25.12 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $56.23 / $89.13
| Professional | | $35.48 | $56.23 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $18.62 / $30.90
| Professional | 26 | $10.47 | $18.62 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $57.54
| Professional | TC | $23.99 | $38.02 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Facility | TC | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $95.50 / $100.00
| Professional | 26 | $12.59 | $95.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $223.87
| Professional | | $36.31 | $57.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $20.42 / $79.43
| Professional | 26 | $10.96 | $20.42 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $33.88 / $67.61
| Professional | TC | $24.55 | $33.88 | $67.61 |