- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $18.20 / $100.00
| Facility | 26 | $10.96 | $18.20 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $131.83
| Professional | | $45.71 | $67.61 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.62 / $56.23
| Professional | 26 | $12.02 | $18.62 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $83.18
| Professional | TC | $34.67 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $57.54 / $77.62
| Professional | | $14.45 | $57.54 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $26.92
| Facility | 26 | $16.60 | $16.60 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $95.50
| Professional | | $48.98 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $17.38 / $26.92
| Professional | 26 | $12.88 | $17.38 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $69.18
| Professional | TC | $36.31 | $43.65 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $125.89 / $125.89
| Facility | 26 | $34.67 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $398.11
| Professional | | $53.70 | $72.44 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $151.36
| Professional | 26 | $13.18 | $17.38 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $309.03
| Professional | TC | $38.02 | $52.48 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $60.26 / $95.50
| Professional | | $51.29 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $16.22 / $29.51
| Professional | 26 | $13.18 | $16.22 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $42.66 / $67.61
| Professional | TC | $37.15 | $42.66 | $67.61 |