- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $81.28
| Facility | 26 | $45.71 | $58.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $281.84 / $467.74
| Professional | | $251.19 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $123.03
| Professional | 26 | $42.66 | $57.54 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $229.09 / $407.38
| Professional | TC | $208.93 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $69.18
| Professional | 26 | $46.77 | $46.77 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $331.13 / $524.81
| Professional | | $295.12 | $331.13 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $48.98 / $77.62
| Professional | 26 | $47.86 | $48.98 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $275.42 / $436.52
| Professional | TC | $251.19 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $426.58 / $691.83
| Professional | | $323.59 | $426.58 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $109.65
| Professional | 26 | $57.54 | $66.07 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $524.81
| Professional | TC | $295.12 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $660.69
| Professional | | $295.12 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $97.72
| Professional | 26 | $45.71 | $58.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $549.54
| Professional | TC | $245.47 | $309.03 | $549.54 |