- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $39.81 / $125.89
| Facility | 26 | $25.12 | $39.81 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $64.57 / $141.25
| Professional | | $42.66 | $64.57 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $28.84 / $69.18
| Professional | 26 | $22.39 | $28.84 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $63.10
| Professional | TC | $16.98 | $34.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $63.10 / $125.89
| Professional | | $38.02 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $64.57
| Professional | 26 | $23.44 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $26.30 / $69.18
| Professional | TC | $14.79 | $26.30 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $32.36 / $91.20
| Facility | 26 | $6.03 | $32.36 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $186.21
| Professional | | $50.12 | $75.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $81.28
| Professional | 26 | $25.70 | $38.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $38.90 / $107.15
| Professional | TC | $19.95 | $38.90 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $66.07 / $138.04
| Professional | | $42.66 | $66.07 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $66.07
| Professional | 26 | $22.91 | $33.11 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $30.90 / $74.13
| Professional | TC | $17.38 | $30.90 | $74.13 |