- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.00 / $16.22
| Facility | 26 | $7.94 | $10.00 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $31.62
| Professional | 26 | $7.94 | $10.96 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $37.15
| Professional | TC | $12.02 | $15.85 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $30.20
| Professional | 26 | $22.91 | $25.12 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $31.62
| Professional | 26 | $23.99 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $56.23
| Professional | 26 | $23.99 | $33.88 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $81.28
| Professional | TC | $35.48 | $48.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $194.98 / $194.98
| Professional | 26 | $144.54 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $302.00 / $302.00
| Professional | TC | $190.55 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $10.47 / $16.22
| Facility | 26 | $7.94 | $10.47 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $12.02 / $37.15
| Professional | 26 | $7.94 | $12.02 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $56.23
| Professional | TC | $12.02 | $17.38 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $32.36 / $51.29
| Professional | 26 | $23.99 | $32.36 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $74.13
| Professional | TC | $35.48 | $47.86 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $41.69
| Professional | 26 | $16.98 | $21.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $47.86
| Professional | TC | $25.12 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $24.55 / $29.51
| Professional | 26 | $23.99 | $24.55 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $43.65
| Professional | TC | $34.67 | $36.31 | $43.65 |