- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $53.70 / $141.25
| Facility | 26 | $28.18 | $53.70 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $128.82 / $295.12
| Professional | | $85.11 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $44.67 / $144.54
| Professional | 26 | $22.91 | $44.67 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $91.20 / $263.03
| Professional | TC | $47.86 | $91.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $75.86 / $257.04
| Professional | | $41.69 | $75.86 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $38.90 / $91.20
| Professional | 26 | $16.60 | $38.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $31.62 / $181.97
| Professional | TC | $9.77 | $31.62 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $51.29 / $123.03
| Facility | 26 | $9.55 | $51.29 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $102.33 / $245.47
| Professional | | $48.98 | $102.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $75.86
| Professional | 26 | $17.38 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $63.10 / $186.21
| Professional | TC | $27.54 | $63.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $114.82 / $263.03
| Professional | | $61.66 | $114.82 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $38.90 / $100.00
| Professional | 26 | $21.88 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $77.62 / $190.55
| Professional | TC | $37.15 | $77.62 | $190.55 |