- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $7.76
| Facility | 26 | $6.03 | $6.03 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $7.08 / $112.20
| Professional | 26 | $5.01 | $7.08 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $91.20
| Professional | TC | $15.85 | $22.91 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $23.99 / $33.11
| Professional | 26 | $12.30 | $23.99 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $81.28 / $117.49
| Professional | TC | $15.85 | $81.28 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $45.71
| Professional | 26 | $22.39 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $93.33 / $147.91
| Professional | TC | $70.79 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.23 / $26.92 / $40.74
| Professional | 26 | $0.23 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.23 / $87.10 / $131.83
| Professional | TC | $0.23 | $87.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.23 / $36.31 / $36.31
| Professional | 26 | $0.23 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.23 / $117.49 / $117.49
| Professional | TC | $0.23 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $24.55 / $34.67
| Professional | 26 | $23.44 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $104.71
| Professional | TC | $72.44 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $43.65
| Professional | 26 | $15.85 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $85.11 / $138.04
| Professional | TC | $50.12 | $85.11 | $138.04 |