- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.30 / $27.54
| Facility | 26 | $10.72 | $12.30 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $338.84
| Facility | TC | $25.12 | $33.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $77.62
| Professional | | $30.20 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $30.20
| Professional | 26 | $10.00 | $16.22 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $67.61
| Professional | TC | $19.95 | $28.18 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $67.61
| Professional | | $25.70 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $13.18 / $21.38
| Professional | 26 | $7.94 | $13.18 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $26.30 / $45.71
| Professional | TC | $17.38 | $26.30 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $338.84 / $407.38
| Facility | TC | $54.95 | $338.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $42.66
| Professional | | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.23 / $177.83
| Professional | 26 | $9.77 | $10.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $85.11
| Professional | | $28.18 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $18.62 / $79.43
| Professional | 26 | $9.12 | $18.62 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $30.20 / $131.83
| Professional | TC | $19.95 | $30.20 | $131.83 |