- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $323.59
| Facility | 26 | $74.13 | $120.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $2,238.72
| Professional | | $398.11 | $588.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $109.65 / $288.40
| Professional | 26 | $70.79 | $109.65 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $446.68 / $1,047.13
| Professional | TC | $302.00 | $446.68 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $524.81 / $1,071.52
| Professional | | $371.54 | $524.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $102.33 / $194.98
| Professional | 26 | $79.43 | $102.33 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $426.58 / $891.25
| Professional | TC | $288.40 | $426.58 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $120.23 / $407.38
| Facility | 26 | $19.95 | $120.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $676.08 / $1,348.96
| Professional | | $398.11 | $676.08 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $234.42
| Professional | 26 | $74.13 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $562.34 / $1,096.48
| Professional | TC | $323.59 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $588.84 / $1,174.90
| Professional | | $371.54 | $588.84 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $204.17
| Professional | 26 | $67.61 | $100.00 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $489.78 / $954.99
| Professional | TC | $316.23 | $489.78 | $954.99 |