- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $4.57 / $10.72
| Facility | 26 | $3.02 | $4.57 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $41.69 / $162.18
| Professional | | $21.88 | $41.69 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.88 / $4.68 / $15.14
| Professional | 26 | $2.88 | $4.68 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $3.47 / $5.25 / $11.48
| Professional | 52 | $3.47 | $5.25 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $87.10
| Professional | TC | $18.20 | $28.84 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $3.24 / $3.24
| Facility | 26 | $3.24 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $46.77 / $151.36
| Professional | | $21.88 | $46.77 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $4.90 / $9.12
| Professional | 26 | $3.02 | $4.90 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $43.65 / $144.54
| Professional | TC | $19.95 | $43.65 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.74 / $3.98 / $10.72
| Facility | 26 | $0.74 | $3.98 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $44.67 / $138.04
| Professional | | $24.55 | $44.67 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $5.01 / $9.12
| Professional | 26 | $3.24 | $5.01 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $123.03
| Professional | TC | $21.88 | $39.81 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $41.69 / $117.49
| Professional | | $22.91 | $41.69 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.95 / $4.27 / $8.51
| Professional | 26 | $2.95 | $4.27 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $109.65
| Professional | TC | $19.50 | $30.20 | $109.65 |