- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $79.43 / $131.83
| Facility | 26 | $26.92 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $95.50 / $199.53
| Professional | | $66.07 | $95.50 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $120.23
| Professional | 26 | $19.05 | $28.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $147.91
| Professional | TC | $45.71 | $67.61 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $234.42
| Professional | | $44.67 | $74.13 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $23.99 / $67.61
| Professional | 26 | $13.49 | $23.99 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $48.98 / $173.78
| Professional | TC | $30.90 | $48.98 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $42.66 / $114.82
| Facility | 26 | $8.13 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $85.11 / $218.78
| Professional | | $37.15 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $26.92 / $60.26
| Professional | 26 | $12.88 | $26.92 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $57.54 / $165.96
| Professional | TC | $24.55 | $57.54 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $104.71 / $234.42
| Professional | | $54.95 | $104.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $87.10
| Professional | 26 | $16.22 | $33.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $74.13 / $169.82
| Professional | TC | $38.02 | $74.13 | $169.82 |