- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $12.02
| Facility | 26 | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $51.29 / $281.84
| Facility | TC | $25.12 | $51.29 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $39.81 / $85.11
| Professional | | $34.67 | $39.81 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $38.90
| Professional | 26 | $10.96 | $13.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $48.98
| Professional | TC | $22.91 | $25.70 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $14.79
| Professional | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.16 / $14.79 / $21.38
| Facility | 26 | $3.16 | $14.79 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $31.62 / $44.67
| Facility | TC | $6.76 | $31.62 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $194.98
| Professional | | $32.36 | $54.95 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $19.05 / $60.26
| Professional | 26 | $10.47 | $19.05 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $134.90
| Professional | TC | $22.91 | $34.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | 26 | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $77.62
| Professional | | $30.20 | $44.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $15.49 / $26.92
| Professional | 26 | $10.00 | $15.49 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $51.29
| Professional | TC | $19.95 | $27.54 | $51.29 |