- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $67.61 / $102.33
| Facility | 26 | $20.42 | $67.61 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $151.36
| Professional | | $44.67 | $60.26 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $63.10
| Professional | 26 | $15.85 | $21.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $38.02 / $91.20
| Professional | TC | $28.18 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $48.98 / $151.36
| Professional | | $25.70 | $48.98 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $25.70 / $60.26
| Professional | 26 | $10.96 | $25.70 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $23.44 / $95.50
| Professional | TC | $5.37 | $23.44 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $32.36 / $107.15
| Facility | 26 | $6.03 | $32.36 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $56.23 / $141.25
| Professional | | $28.84 | $56.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $23.99 / $51.29
| Professional | 26 | $12.02 | $23.99 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $32.36 / $93.33
| Professional | TC | $14.79 | $32.36 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $67.61 / $147.91
| Professional | | $36.31 | $67.61 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $26.30 / $67.61
| Professional | 26 | $14.45 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $40.74 / $97.72
| Professional | TC | $21.38 | $40.74 | $97.72 |