- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $331.13 / $331.13
| Facility | 26 | $302.00 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,047.13 / $1,737.80
| Professional | | $851.14 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $426.58 / $645.65
| Professional | 26 | $263.03 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $776.25 / $1,258.93
| Professional | TC | $660.69 | $776.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,412.54 / $2,089.30
| Professional | | $575.44 | $1,412.54 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $323.59 / $467.74
| Facility | 26 | $70.79 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,548.82 / $4,677.35
| Professional | | $977.24 | $1,548.82 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $489.78 / $1,348.96
| Professional | 26 | $275.42 | $489.78 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $1,122.02 / $3,311.31
| Professional | TC | $691.83 | $1,122.02 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,258.93 / $1,905.46
| Professional | | $831.76 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $562.34
| Professional | 26 | $239.88 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $851.14 / $1,380.38
| Professional | TC | $575.44 | $851.14 | $1,380.38 |