- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $53.70
| Facility | 26 | $12.88 | $19.95 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $87.10 / $251.19
| Professional | | $56.23 | $87.10 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $22.39 / $61.66
| Professional | 26 | $12.88 | $22.39 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $57.54 / $125.89
| Professional | TC | $40.74 | $57.54 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $158.49
| Professional | | $56.23 | $75.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $37.15
| Professional | 26 | $13.49 | $19.95 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $58.88 / $120.23
| Professional | TC | $42.66 | $58.88 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.72 / $19.50 / $53.70
| Facility | 26 | $3.72 | $19.50 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $173.78
| Professional | | $53.70 | $87.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $21.38 / $40.74
| Professional | 26 | $12.59 | $21.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $138.04
| Professional | TC | $40.74 | $66.07 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $190.55
| Professional | | $54.95 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $19.95 / $87.10
| Professional | 26 | $13.80 | $19.95 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $63.10 / $165.96
| Professional | TC | $41.69 | $63.10 | $165.96 |