- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.98 / $22.91
| Facility | 26 | $13.18 | $16.98 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $51.29 / $125.89
| Facility | TC | $35.48 | $51.29 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $72.44 / $138.04
| Professional | | $43.65 | $72.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $19.50 / $37.15
| Professional | 26 | $12.02 | $19.50 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $75.86 / $100.00
| Professional | 50 | $29.51 | $75.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $79.43
| Professional | TC | $30.20 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $48.98 / $95.50
| Professional | | $36.31 | $48.98 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $16.22 / $26.30
| Professional | 26 | $10.72 | $16.22 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $74.13
| Professional | TC | $25.12 | $29.51 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $93.33
| Professional | | $43.65 | $60.26 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $19.50 / $30.20
| Professional | 26 | $14.79 | $19.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $138.04
| Professional | 50 | $66.07 | $89.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $64.57
| Professional | TC | $29.51 | $40.74 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $44.67 / $66.07
| Professional | | $14.79 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $61.66 / $100.00
| Professional | | $42.66 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.62 / $30.20
| Professional | 26 | $12.02 | $18.62 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $74.13
| Professional | TC | $30.20 | $42.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $93.33
| Professional | | $44.67 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.22 / $31.62
| Professional | 26 | $12.88 | $16.22 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $64.57
| Professional | TC | $30.90 | $37.15 | $64.57 |