- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $208.93
| Facility | 26 | $25.12 | $35.48 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $70.79 / $109.65
| Professional | | $48.98 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $44.67
| Professional | 26 | $20.42 | $29.51 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $39.81 / $64.57
| Professional | TC | $28.84 | $39.81 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $52.48
| Facility | 26 | $30.20 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $128.82
| Professional | | $66.07 | $87.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $52.48
| Professional | 26 | $27.54 | $33.88 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $79.43
| Professional | TC | $38.02 | $52.48 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $144.54
| Facility | 26 | $74.13 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $588.84
| Professional | | $77.62 | $102.33 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $338.84
| Professional | 26 | $31.62 | $38.90 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $354.81
| Professional | TC | $51.29 | $64.57 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $97.72 / $131.83
| Professional | | $75.86 | $97.72 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $51.29
| Professional | 26 | $29.51 | $35.48 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $63.10 / $77.62
| Professional | TC | $48.98 | $63.10 | $77.62 |