- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $63.10
| Facility | 26 | $12.59 | $22.39 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $54.95 / $134.90
| Professional | | $40.74 | $54.95 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $14.13 / $35.48
| Professional | 26 | $10.96 | $14.13 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $77.62
| Professional | TC | $28.84 | $38.02 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $16.60
| Facility | 26 | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $154.88
| Professional | | $47.86 | $64.57 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $17.78 / $39.81
| Professional | 26 | $11.75 | $17.78 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $114.82
| Professional | TC | $35.48 | $47.86 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $18.20 / $50.12
| Facility | 26 | $3.47 | $18.20 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $141.25
| Professional | | $42.66 | $74.13 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.95 / $38.02
| Professional | 26 | $11.75 | $19.95 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $107.15
| Professional | TC | $31.62 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $66.07 / $158.49
| Professional | | $41.69 | $66.07 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $18.62 / $87.10
| Professional | 26 | $11.22 | $18.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $44.67 / $89.13
| Professional | TC | $28.84 | $44.67 | $89.13 |