- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $134.90
| Facility | 26 | $25.12 | $47.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $288.40
| Professional | | $83.18 | $114.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $151.36
| Professional | 26 | $22.91 | $37.15 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $186.21
| Professional | TC | $61.66 | $85.11 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $257.04
| Professional | | $53.70 | $81.28 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $20.42 / $66.07
| Professional | 26 | $14.79 | $20.42 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $194.98
| Professional | TC | $38.90 | $56.23 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $81.28 / $151.36
| Facility | 26 | $15.14 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $117.49 / $281.84
| Professional | | $47.86 | $117.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $31.62 / $70.79
| Professional | 26 | $13.49 | $31.62 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $87.10 / $213.80
| Professional | TC | $34.67 | $87.10 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $109.65 / $251.19
| Professional | | $61.66 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $30.90 / $79.43
| Professional | 26 | $16.98 | $30.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $81.28 / $186.21
| Professional | TC | $44.67 | $81.28 | $186.21 |