- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $7.59 / $16.60
| Facility | 26 | $6.46 | $7.59 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $794.33
| Facility | TC | $30.20 | $43.65 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $41.69 / $91.20
| Professional | | $13.80 | $41.69 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $33.88
| Professional | 26 | $6.03 | $10.00 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $63.10 / $144.54 / $371.54
| Professional | 50 | $63.10 | $144.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $26.30
| Professional | 52 | $19.50 | $19.50 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $33.88 / $79.43
| Professional | TC | $22.39 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $66.07
| Professional | | $21.88 | $32.36 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.90 / $7.59 / $13.80
| Professional | 26 | $4.90 | $7.59 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $52.48
| Professional | TC | $18.20 | $26.30 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | TC | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $66.07
| Professional | | $41.69 | $41.69 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.51 / $54.95
| Professional | 26 | $6.03 | $8.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $29.51
| Professional | TC | $28.84 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $46.77 / $85.11
| Professional | | $26.30 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.25 / $9.77 / $79.43
| Professional | 26 | $5.25 | $9.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $34.67 / $158.49
| Professional | TC | $20.42 | $34.67 | $158.49 |