- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $363.08 / $363.08
| Facility | 26 | $331.13 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,949.84 / $3,090.30
| Professional | | $1,348.96 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $512.86 / $891.25
| Professional | 26 | $371.54 | $512.86 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,023.29 / $1,513.56 / $2,398.83
| Professional | TC | $1,023.29 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,884.03 / $3,801.89
| Professional | | $954.99 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $478.63 / $691.83
| Facility | 26 | $102.33 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,398.83 / $8,709.64
| Professional | | $1,445.44 | $2,398.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $1,023.29 / $1,995.26
| Professional | 26 | $389.05 | $1,023.29 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,258.93 / $3,388.44 / $6,760.83
| Professional | TC | $1,258.93 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $588.84 / $691.83 / $977.24
| Professional | 26 | $588.84 | $691.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $3,235.94
| Professional | | $1,230.27 | $1,659.59 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $660.69
| Professional | 26 | $269.15 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $977.24 / $1,288.25 / $2,511.89
| Professional | TC | $977.24 | $1,288.25 | $2,511.89 |