- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $14.45 / $31.62
| Facility | 26 | $12.30 | $14.45 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $32.36 / $74.13
| Facility | TC | $28.84 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $85.11
| Professional | | $32.36 | $40.74 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $14.13 / $31.62
| Professional | 26 | $10.00 | $14.13 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $56.23
| Professional | TC | $20.89 | $27.54 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $45.71 / $77.62
| Professional | | $29.51 | $45.71 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $15.85 / $25.70
| Professional | 26 | $9.33 | $15.85 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $52.48
| Professional | TC | $19.95 | $29.51 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $263.03
| Facility | TC | $64.57 | $64.57 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $131.83
| Professional | 26 | $12.02 | $12.02 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $53.70 / $213.80
| Professional | | $32.36 | $53.70 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $16.60 / $66.07
| Professional | 26 | $10.23 | $16.60 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $63.10
| Professional | TC | $21.88 | $28.84 | $63.10 |