- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $29.51 / $37.15
| Facility | 26 | $15.49 | $29.51 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $67.61
| Professional | | $18.20 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $26.92
| Professional | 26 | $6.03 | $10.00 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $38.90
| Professional | TC | $12.02 | $16.98 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $18.20
| Professional | | $16.98 | $16.98 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.89 / $6.03 / $7.24
| Professional | 26 | $5.89 | $6.03 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $102.33
| Professional | | $20.89 | $25.12 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $7.24 / $29.51
| Professional | 26 | $6.17 | $7.24 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $72.44
| Professional | TC | $14.79 | $17.78 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $8.71 / $12.59
| Facility | 26 | $1.86 | $8.71 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $51.29
| Professional | | $19.50 | $27.54 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.51 / $16.98
| Professional | 26 | $6.31 | $8.51 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $18.20 / $34.67
| Professional | TC | $12.88 | $18.20 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $100.00 / $100.00
| Facility | 26 | $18.20 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $537.03
| Professional | | $21.88 | $25.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $8.32 / $63.10
| Professional | 26 | $7.24 | $8.32 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $17.38 / $501.19
| Professional | TC | $14.45 | $17.38 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $24.55 / $39.81
| Professional | | $21.88 | $24.55 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.32 / $45.71
| Professional | 26 | $7.08 | $8.32 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $16.60 / $25.70
| Professional | TC | $14.45 | $16.60 | $25.70 |