- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $10.47 / $10.47
| Facility | 26 | $8.91 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $97.72
| Professional | | $15.14 | $19.05 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $25.70
| Professional | 26 | $7.94 | $10.00 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $14.13
| Professional | TC | $6.03 | $8.91 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $18.62 / $40.74
| Professional | | $9.33 | $18.62 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.45 / $11.48 / $16.22
| Facility | 26 | $2.45 | $11.48 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $32.36 / $141.25
| Professional | | $14.45 | $32.36 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $14.45 / $47.86
| Professional | 26 | $7.94 | $14.45 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.61 / $16.98 / $45.71
| Professional | TC | $6.61 | $16.98 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $25.12 / $26.30
| Professional | 26 | $10.00 | $25.12 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $28.18 / $47.86
| Professional | | $15.49 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.48 / $21.38
| Professional | 26 | $7.08 | $11.48 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $13.49 / $30.20
| Professional | TC | $6.76 | $13.49 | $30.20 |