- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $11.48 / $17.38
| Facility | 26 | $10.00 | $11.48 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $67.61
| Professional | | $33.11 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $15.85 / $23.99
| Professional | 26 | $8.91 | $15.85 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $56.23
| Professional | TC | $23.99 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $40.74 / $85.11
| Professional | | $14.13 | $40.74 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.63 / $12.30 / $17.38
| Facility | 26 | $2.63 | $12.30 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $57.54 / $199.53
| Professional | | $31.62 | $57.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $15.49 / $53.70
| Professional | 26 | $8.71 | $15.49 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $45.71 / $141.25
| Professional | TC | $23.44 | $45.71 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $18.20 / $27.54
| Professional | 26 | $16.98 | $18.20 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | TC | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $83.18
| Professional | | $32.36 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.30 / $22.91
| Professional | 26 | $7.94 | $12.30 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $64.57
| Professional | TC | $21.88 | $35.48 | $64.57 |