- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.71 / $10.47
| Facility | 26 | $7.94 | $8.71 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $21.38 / $75.86
| Professional | 26 | $5.01 | $21.38 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $117.49
| Professional | TC | $18.20 | $23.99 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $23.44 / $47.86
| Professional | 26 | $22.91 | $23.44 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | 26 | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $194.98
| Professional | TC | $123.03 | $123.03 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $97.72
| Professional | 26 | $23.44 | $31.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $104.71 / $316.23
| Professional | TC | $74.13 | $104.71 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $23.44 / $67.61
| Facility | 26 | $8.32 | $23.44 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $23.44 / $51.29
| Professional | 26 | $6.03 | $23.44 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $72.44 / $112.20
| Professional | TC | $19.95 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $30.90 / $40.74
| Professional | 26 | $23.44 | $30.90 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $141.25
| Professional | TC | $74.13 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $51.29
| Professional | 26 | $20.89 | $30.20 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $93.33 / $154.88
| Professional | TC | $60.26 | $93.33 | $154.88 |