- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $87.10 / $134.90
| Facility | 26 | $26.92 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $269.15
| Professional | | $70.79 | $100.00 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $93.33
| Professional | 26 | $21.88 | $30.20 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $69.18 / $204.17
| Professional | TC | $47.86 | $69.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $426.58
| Professional | | $104.71 | $144.54 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $46.77 / $128.82
| Professional | 26 | $23.99 | $46.77 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $309.03
| Professional | TC | $81.28 | $107.15 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $54.95 / $114.82
| Facility | 26 | $10.47 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $125.89 / $338.84
| Professional | | $52.48 | $125.89 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $34.67 / $93.33
| Professional | 26 | $15.85 | $34.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $89.13 / $234.42
| Professional | TC | $36.31 | $89.13 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $288.40
| Professional | | $64.57 | $125.89 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $36.31 / $85.11
| Professional | 26 | $20.42 | $36.31 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $87.10 / $204.17
| Professional | TC | $44.67 | $87.10 | $204.17 |