- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.00 / $45.71
| Facility | 26 | $6.03 | $10.00 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $28.84 / $52.48
| Professional | | $10.72 | $28.84 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $10.72 / $28.18
| Professional | 26 | $6.03 | $10.72 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $40.74
| Professional | TC | $16.98 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $38.02
| Professional | | $20.89 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $6.17 / $10.47
| Professional | 26 | $6.17 | $6.17 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $30.90
| Professional | TC | $22.91 | $26.92 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $29.51 / $40.74
| Professional | | $8.13 | $29.51 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $11.75
| Facility | 26 | $7.41 | $7.41 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $45.71
| Professional | | $22.39 | $28.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $7.94 / $13.18
| Professional | 26 | $6.61 | $7.94 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $20.42 / $30.90
| Professional | TC | $15.14 | $20.42 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $100.00 / $100.00
| Facility | 26 | $18.62 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $208.93
| Professional | | $25.70 | $33.88 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $8.71 / $79.43
| Professional | 26 | $7.41 | $8.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $22.39 / $162.18
| Professional | TC | $17.38 | $22.39 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $53.70
| Professional | | $23.99 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $8.32 / $16.60
| Professional | 26 | $7.41 | $8.32 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $21.38 / $37.15
| Professional | TC | $17.38 | $21.38 | $37.15 |