- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $63.10
| Facility | 26 | $26.30 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $67.61 / $173.78
| Professional | | $56.23 | $67.61 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $79.43
| Professional | 26 | $25.12 | $34.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $67.61
| Professional | TC | $28.84 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $74.13 / $151.36
| Professional | | $50.12 | $74.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $61.66
| Professional | 26 | $25.70 | $34.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $87.10
| Professional | TC | $27.54 | $41.69 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $35.48 / $87.10
| Facility | 26 | $6.61 | $35.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $186.21
| Professional | | $60.26 | $85.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $75.86
| Professional | 26 | $27.54 | $38.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $44.67 / $112.20
| Professional | TC | $31.62 | $44.67 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $75.86 / $162.18
| Professional | | $51.29 | $75.86 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $35.48 / $69.18
| Professional | 26 | $23.99 | $35.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $81.28
| Professional | TC | $26.30 | $39.81 | $81.28 |