- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $120.23 / $120.23
| Facility | 26 | $107.15 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $489.78 / $3,467.37
| Professional | | $398.11 | $489.78 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $251.19
| Professional | 26 | $100.00 | $141.25 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $676.08
| Professional | TC | $281.84 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $123.03 / $173.78
| Facility | 26 | $26.30 | $123.03 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,071.52 / $4,466.84
| Professional | | $389.05 | $1,071.52 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $154.88 / $537.03
| Professional | 26 | $87.10 | $154.88 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $870.96 / $2,691.53
| Professional | TC | $309.03 | $870.96 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $165.96 / $186.21 / $288.40
| Professional | 26 | $165.96 | $186.21 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $891.25 / $1,548.82
| Professional | | $380.19 | $891.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $125.89 / $223.87
| Professional | 26 | $66.07 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $741.31 / $1,380.38
| Professional | TC | $302.00 | $741.31 | $1,380.38 |