- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $33.88
| Facility | 26 | $26.92 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $70.79 / $128.82
| Professional | | $40.74 | $70.79 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $33.88 / $181.97
| Professional | 26 | $16.98 | $33.88 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $83.18
| Professional | TC | $25.12 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $87.10 / $95.50
| Professional | | $75.86 | $87.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $51.29
| Professional | 26 | $32.36 | $32.36 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $53.70 / $57.54
| Professional | TC | $35.48 | $53.70 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $26.30 / $67.61
| Professional | 26 | $25.70 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $117.49
| Professional | | $30.20 | $35.48 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $19.50 / $44.67
| Professional | 26 | $12.59 | $19.50 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $74.13
| Professional | TC | $14.45 | $22.91 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $69.18 / $117.49
| Professional | | $32.36 | $69.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $50.12
| Professional | 26 | $17.38 | $29.51 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $67.61
| Professional | TC | $19.95 | $40.74 | $67.61 |