- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.79 / $16.22
| Facility | 26 | $14.13 | $14.79 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $147.91
| Professional | | $57.54 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $25.12 / $33.88
| Professional | 26 | $12.88 | $25.12 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $52.48 / $104.71
| Professional | TC | $43.65 | $52.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $72.44 / $144.54
| Professional | | $19.95 | $72.44 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.72 / $17.38 / $24.55
| Facility | 26 | $3.72 | $17.38 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $91.20 / $331.13
| Professional | | $53.70 | $91.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $70.79
| Professional | 26 | $12.02 | $21.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $257.04
| Professional | TC | $42.66 | $64.57 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $39.81
| Professional | 26 | $23.44 | $26.92 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $69.18 / $125.89
| Professional | | $48.98 | $69.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $18.62 / $33.11
| Professional | 26 | $11.75 | $18.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $97.72
| Professional | TC | $37.15 | $51.29 | $97.72 |