- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $19.05 / $51.29
| Facility | 26 | $12.30 | $19.05 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $109.65 / $446.68
| Facility | TC | $38.90 | $109.65 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $147.91
| Professional | | $41.69 | $64.57 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.05 / $42.66
| Professional | 26 | $12.02 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $75.86 / $269.15
| Professional | 50 | $29.51 | $75.86 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $100.00
| Professional | TC | $28.84 | $41.69 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $16.22
| Facility | 26 | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Facility | TC | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $123.03
| Professional | | $43.65 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $34.67
| Professional | 26 | $12.30 | $18.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $158.49
| Professional | 50 | $66.07 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $89.13
| Professional | TC | $30.20 | $42.66 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $18.20 / $50.12
| Facility | 26 | $3.47 | $18.20 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $50.12 / $147.91
| Facility | TC | $9.33 | $50.12 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $134.90
| Professional | | $41.69 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.95 / $38.02
| Professional | 26 | $11.75 | $19.95 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $48.98 / $100.00
| Professional | TC | $29.51 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $141.25
| Professional | | $42.66 | $63.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $18.62 / $87.10
| Professional | 26 | $12.59 | $18.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $41.69 / $83.18
| Professional | TC | $29.51 | $41.69 | $83.18 |