- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $14.45 / $14.45
| Facility | 26 | $12.88 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $436.52 / $602.56
| Facility | TC | $354.81 | $436.52 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $45.71 / $77.62
| Professional | | $37.15 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.60 / $30.90
| Professional | 26 | $10.96 | $16.60 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $46.77
| Professional | TC | $25.12 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Professional | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $15.14 / $21.88
| Facility | 26 | $3.24 | $15.14 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.24 / $33.88 / $48.98
| Facility | TC | $7.24 | $33.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $229.09
| Professional | | $34.67 | $61.66 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $19.50 / $81.28
| Professional | 26 | $10.72 | $19.50 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $40.74 / $147.91
| Professional | TC | $23.99 | $40.74 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $398.11 / $575.44
| Facility | TC | $245.47 | $398.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $38.90
| Professional | 26 | $22.91 | $34.67 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $89.13
| Professional | | $35.48 | $50.12 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $16.98 / $29.51
| Professional | 26 | $11.48 | $16.98 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $34.67 / $60.26
| Professional | TC | $22.39 | $34.67 | $60.26 |