- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $45.71 / $67.61
| Facility | 26 | $40.74 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $758.58
| Professional | | $102.33 | $169.82 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $89.13
| Professional | 26 | $36.31 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $120.23 / $275.42
| Professional | TC | $64.57 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $229.09
| Professional | | $52.48 | $95.50 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $45.71 / $66.07
| Facility | 26 | $9.77 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $239.88 / $977.24
| Professional | | $89.13 | $239.88 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $57.54 / $199.53
| Professional | 26 | $32.36 | $57.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $162.18 / $562.34
| Professional | TC | $54.95 | $162.18 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $107.15
| Professional | 26 | $63.10 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $120.23
| Professional | TC | $112.20 | $112.20 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $194.98 / $380.19
| Professional | | $77.62 | $194.98 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $48.98 / $85.11
| Professional | 26 | $25.70 | $48.98 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $125.89 / $288.40
| Professional | TC | $54.95 | $125.89 | $288.40 |