- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $16.22 / $19.05
| Facility | 26 | $13.49 | $16.22 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $275.42
| Facility | TC | $38.90 | $45.71 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $63.10 / $134.90
| Professional | | $42.66 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.62 / $40.74
| Professional | 26 | $12.02 | $18.62 | $40.74 |
- 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 / $40.74 / $109.65
| Professional | TC | $28.84 | $40.74 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $97.72
| Professional | | $38.02 | $57.54 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $17.78 / $28.18
| Professional | 26 | $10.23 | $17.78 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $70.79
| Professional | TC | $28.18 | $40.74 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Facility | TC | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.18 / $18.20
| Professional | 26 | $12.88 | $13.18 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $60.26 / $275.42
| Professional | | $42.66 | $60.26 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $20.42 / $79.43
| Professional | 26 | $11.22 | $20.42 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.90 / $85.11
| Professional | TC | $29.51 | $38.90 | $85.11 |