- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $67.61
| Facility | 26 | $7.94 | $10.96 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $69.18
| Professional | | $30.90 | $40.74 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $20.89
| Professional | 26 | $7.94 | $10.00 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $48.98
| Professional | TC | $21.88 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $38.02 / $52.48
| Professional | | $10.47 | $38.02 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $16.22
| Facility | 26 | $10.00 | $10.00 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $57.54
| Professional | | $28.84 | $35.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $10.72 / $16.98
| Professional | 26 | $8.71 | $10.72 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $39.81
| Professional | TC | $19.95 | $26.92 | $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
- $33.11 / $43.65 / $269.15
| Professional | | $33.11 | $43.65 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $11.75 / $85.11
| Professional | 26 | $9.77 | $11.75 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $28.84 / $245.47
| Professional | TC | $22.39 | $28.84 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $38.02 / $64.57
| Professional | | $31.62 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.96 / $21.88
| Professional | 26 | $9.77 | $10.96 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $39.81
| Professional | TC | $21.88 | $27.54 | $39.81 |