- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $43.65 / $114.82
| Facility | 26 | $23.44 | $43.65 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $602.56
| Professional | | $61.66 | $109.65 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $194.98 / $707.95
| Professional | 26 | $20.89 | $194.98 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $70.79 / $199.53
| Professional | TC | $34.67 | $70.79 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $66.07 / $208.93
| Professional | | $29.51 | $66.07 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $26.30 / $72.44
| Professional | 26 | $12.02 | $26.30 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $39.81 / $147.91
| Professional | TC | $17.38 | $39.81 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $51.29 / $100.00
| Facility | 26 | $9.55 | $51.29 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $77.62 / $186.21
| Professional | | $36.31 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $26.92 / $53.70
| Professional | 26 | $13.80 | $26.92 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $51.29 / $138.04
| Professional | TC | $21.38 | $51.29 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $85.11 / $199.53
| Professional | | $45.71 | $85.11 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $30.20 / $95.50
| Professional | 26 | $16.60 | $30.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $57.54 / $147.91
| Professional | TC | $28.84 | $57.54 | $147.91 |