- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $251.19
| Facility | 26 | $23.44 | $34.67 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $263.03
| Professional | | $89.13 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $89.13
| Professional | 26 | $21.88 | $34.67 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $199.53
| Professional | TC | $67.61 | $100.00 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $32.36
| Professional | 26 | $18.62 | $26.30 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $199.53
| Professional | | $109.65 | $154.88 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $57.54 / $74.13
| Professional | 26 | $40.74 | $57.54 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $97.72 / $125.89
| Professional | TC | $67.61 | $97.72 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | 26 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $117.49 / $275.42
| Professional | | $70.79 | $117.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $66.07
| Professional | 26 | $21.38 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $97.72 / $245.47
| Professional | TC | $54.95 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $117.49 / $173.78
| Professional | | $72.44 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $51.29
| Professional | 26 | $20.89 | $26.30 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $89.13 / $125.89
| Professional | TC | $48.98 | $89.13 | $125.89 |