- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $87.10
| Facility | 26 | $32.36 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $104.71 / $263.03
| Professional | | $69.18 | $104.71 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $134.90
| Professional | 26 | $30.20 | $36.31 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $102.33
| Professional | TC | $34.67 | $67.61 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $83.18 / $190.55
| Professional | | $53.70 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $75.86
| Professional | 26 | $30.20 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $43.65 / $125.89
| Professional | TC | $16.22 | $43.65 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $43.65 / $123.03
| Facility | 26 | $8.13 | $43.65 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $295.12
| Professional | | $63.10 | $123.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $100.00
| Professional | 26 | $33.11 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $77.62 / $199.53
| Professional | TC | $23.44 | $77.62 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $239.88
| Professional | | $60.26 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $43.65 / $85.11
| Professional | 26 | $30.20 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $64.57 / $144.54
| Professional | TC | $24.55 | $64.57 | $144.54 |