- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Facility | 26 | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $234.42 / $234.42
| Facility | TC | $81.28 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $54.95
| Professional | | $15.85 | $24.55 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $7.94 / $33.11
| Professional | 26 | $5.01 | $7.94 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $100.00 / $107.15 / $109.65
| Professional | 50 | $100.00 | $107.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $36.31
| Professional | TC | $10.96 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $50.12
| Professional | | $19.05 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $9.12 / $15.14
| Professional | 26 | $6.31 | $9.12 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $17.38 / $23.99
| Professional | TC | $12.59 | $17.38 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $50.12
| Professional | | $20.89 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $10.96 / $16.60
| Professional | 26 | $7.08 | $10.96 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $26.92 / $34.67
| Professional | TC | $13.80 | $26.92 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $36.31
| Professional | | $20.89 | $26.92 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $8.91 / $12.30
| Professional | 26 | $6.92 | $8.91 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $22.91
| Professional | TC | $13.80 | $17.38 | $22.91 |