- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $18.20 / $74.13
| Facility | 26 | $7.94 | $18.20 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.02 / $63.10
| Professional | | $28.18 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.30 / $29.51
| Professional | 26 | $7.94 | $12.30 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $45.71
| Professional | TC | $19.05 | $28.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $10.00
| Professional | 26 | $7.94 | $7.94 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $34.67 / $47.86
| Professional | | $10.47 | $34.67 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $18.20
| Facility | 26 | $11.22 | $11.22 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $58.88
| Professional | | $30.20 | $38.02 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $12.02 / $18.20
| Professional | 26 | $9.33 | $12.02 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $24.55 / $39.81
| Professional | TC | $19.95 | $24.55 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $100.00 / $100.00
| Facility | 26 | $24.55 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $263.03
| Professional | | $32.36 | $42.66 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $12.59 / $107.15
| Professional | 26 | $10.00 | $12.59 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $251.19
| Professional | TC | $20.89 | $29.51 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $61.66
| Professional | | $30.90 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $11.75 / $22.39
| Professional | 26 | $9.77 | $11.75 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.12 / $41.69
| Professional | TC | $20.42 | $25.12 | $41.69 |