- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.22 / $23.44
| Facility | 26 | $10.00 | $16.22 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $57.54 / $95.50
| Professional | | $39.81 | $57.54 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $45.71
| Professional | 26 | $10.96 | $16.98 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $42.66 / $64.57
| Professional | TC | $28.84 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $67.61
| Professional | | $33.88 | $42.66 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $16.60
| Professional | 26 | $10.00 | $10.00 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $48.98
| Professional | TC | $25.70 | $38.02 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $48.98 / $66.07
| Professional | | $12.88 | $48.98 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $22.91
| Facility | 26 | $14.13 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $75.86
| Professional | | $39.81 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $23.44
| Professional | 26 | $11.75 | $14.79 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $52.48
| Professional | TC | $27.54 | $35.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $109.65 / $109.65
| Facility | 26 | $30.90 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $346.74
| Professional | | $41.69 | $57.54 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $15.49 / $114.82
| Professional | 26 | $12.30 | $15.49 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $257.04
| Professional | TC | $28.18 | $37.15 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $85.11
| Professional | | $40.74 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.45 / $27.54
| Professional | 26 | $12.02 | $14.45 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $61.66
| Professional | TC | $28.18 | $35.48 | $61.66 |