- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $93.33 / $93.33
| Facility | 26 | $54.95 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $446.68 / $707.95
| Professional | | $363.08 | $446.68 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $75.86 / $173.78
| Professional | 26 | $53.70 | $75.86 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $380.19 / $588.84
| Professional | TC | $309.03 | $380.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $64.57 / $102.33
| Professional | 26 | $57.54 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $446.68 / $524.81
| Professional | | $309.03 | $446.68 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $77.62
| Professional | 26 | $45.71 | $64.57 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $380.19 / $446.68
| Professional | TC | $269.15 | $380.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $831.76
| Professional | | $346.74 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $128.82
| Professional | 26 | $53.70 | $79.43 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $416.87 / $724.44
| Professional | TC | $269.15 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $416.87 / $776.25
| Professional | | $295.12 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $125.89
| Professional | 26 | $45.71 | $69.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $645.65
| Professional | TC | $263.03 | $363.08 | $645.65 |