- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $436.52 / $478.63
| Facility | 26 | $346.74 | $436.52 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,000.00 / $2,290.87
| Professional | | $691.83 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $891.25 / $1,995.26
| Professional | TC | $616.60 | $891.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,000.00 / $7,079.46
| Professional | | $977.24 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $870.96 / $891.25 / $6,309.57
| Professional | TC | $870.96 | $891.25 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $954.99 / $1,584.89
| Professional | | $512.86 | $954.99 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $831.76 / $1,380.38
| Professional | TC | $416.87 | $831.76 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $446.68 / $446.68
| Facility | 26 | $223.87 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,071.52 / $6,456.54
| Professional | | $660.69 | $1,071.52 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $954.99 / $5,754.40
| Professional | TC | $537.03 | $954.99 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,000.00 / $1,548.82
| Professional | | $660.69 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $1,380.38
| Professional | TC | $537.03 | $870.96 | $1,380.38 |