- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $138.04 / $234.42
| Facility | 26 | $46.77 | $138.04 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $501.19 / $1,023.29
| Professional | | $389.05 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $125.89
| Professional | 26 | $36.31 | $47.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $954.99
| Professional | TC | $346.74 | $446.68 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $1,288.25
| Professional | | $257.04 | $467.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $47.86 / $125.89
| Professional | 26 | $24.55 | $47.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $1,174.90
| Professional | TC | $234.42 | $416.87 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $74.13 / $199.53
| Facility | 26 | $13.80 | $74.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $1,047.13
| Professional | | $275.42 | $501.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $51.29 / $107.15
| Professional | 26 | $28.18 | $51.29 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $933.25
| Professional | TC | $245.47 | $457.09 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $549.54 / $1,174.90
| Professional | | $302.00 | $549.54 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $123.03
| Professional | 26 | $32.36 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $489.78 / $1,047.13
| Professional | TC | $275.42 | $489.78 | $1,047.13 |