- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $26.30 / $33.11
| Facility | 26 | $22.39 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $223.87
| Professional | | $70.79 | $100.00 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $44.67
| Professional | 26 | $16.98 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $138.04
| Professional | TC | $53.70 | $72.44 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $112.20
| Professional | | $57.54 | $66.07 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $28.18 / $31.62
| Professional | 26 | $15.14 | $28.18 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $100.00 / $158.49
| Professional | | $72.44 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $40.74
| Professional | 26 | $19.95 | $26.30 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $114.82
| Professional | TC | $52.48 | $72.44 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $186.21
| Professional | | $74.13 | $104.71 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $41.69
| Professional | 26 | $16.98 | $25.12 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $162.18
| Professional | TC | $58.88 | $81.28 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $165.96
| Professional | | $75.86 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $22.39 / $40.74
| Professional | 26 | $18.20 | $22.39 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $70.79 / $125.89
| Professional | TC | $56.23 | $70.79 | $125.89 |