- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $66.07 / $204.17
| Facility | 26 | $40.74 | $66.07 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $89.13 / $194.98
| Professional | | $69.18 | $89.13 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $48.98 / $125.89
| Professional | 26 | $38.02 | $48.98 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $77.62
| Professional | TC | $25.12 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $186.21
| Professional | | $56.23 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $109.65
| Professional | 26 | $38.02 | $58.88 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $37.15 / $85.11
| Professional | TC | $19.05 | $37.15 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $52.48 / $147.91
| Facility | 26 | $10.00 | $52.48 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $263.03
| Professional | | $77.62 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $134.90
| Professional | 26 | $42.66 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $48.98 / $131.83
| Professional | TC | $28.18 | $48.98 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $97.72 / $199.53
| Professional | | $64.57 | $97.72 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $56.23 / $109.65
| Professional | 26 | $37.15 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $93.33
| Professional | TC | $23.99 | $39.81 | $93.33 |