- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $18.62 / $47.86
| Facility | 26 | $6.03 | $18.62 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $40.74 / $100.00
| Facility | TC | $14.13 | $40.74 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $61.66
| Professional | | $14.45 | $20.89 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $12.88 / $25.12
| Professional | 26 | $6.03 | $12.88 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $109.65 / $269.15
| Professional | 50 | $100.00 | $109.65 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $48.98
| Professional | TC | $10.96 | $15.14 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $21.88 / $95.50
| Professional | | $7.41 | $21.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.76 / $7.76
| Professional | 26 | $6.92 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $17.78
| Professional | TC | $14.79 | $16.60 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $58.88
| Professional | | $19.05 | $29.51 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $8.91 / $17.78
| Professional | 26 | $6.17 | $8.91 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $20.42 / $41.69
| Professional | TC | $12.88 | $20.42 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.12 / $51.29
| Professional | | $21.38 | $25.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $7.94 / $16.22
| Professional | 26 | $6.76 | $7.94 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $16.98 / $34.67
| Professional | TC | $14.45 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $63.10 / $151.36
| Professional | | $20.42 | $63.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $45.71 / $95.50
| Professional | 26 | $7.08 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $43.65 / $104.71
| Professional | TC | $13.49 | $43.65 | $104.71 |