- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $44.67
| Facility | 26 | $30.20 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $165.96
| Professional | | $64.57 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $112.20
| Professional | 26 | $28.18 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $87.10
| Professional | TC | $37.15 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $38.02
| Professional | 26 | $24.55 | $24.55 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $104.71
| Professional | | $56.23 | $81.28 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $43.65
| Professional | 26 | $23.99 | $34.67 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $46.77 / $60.26
| Professional | TC | $32.36 | $46.77 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $173.78
| Professional | | $57.54 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $81.28
| Professional | 26 | $28.18 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $107.15
| Professional | TC | $39.81 | $56.23 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $79.43 / $141.25
| Professional | | $61.66 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $69.18
| Professional | 26 | $26.92 | $34.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $64.57
| Professional | TC | $34.67 | $45.71 | $64.57 |