- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $281.84 / $407.38
| Facility | 26 | $100.00 | $281.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $977.24 / $2,398.83
| Professional | | $758.58 | $977.24 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $870.96 / $1,949.84
| Professional | TC | $676.08 | $870.96 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $870.96 / $1,778.28
| Professional | | $691.83 | $870.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,584.89
| Professional | TC | $588.84 | $741.31 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,122.02 / $1,698.24
| Professional | | $812.83 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $1,000.00 / $1,513.56
| Professional | TC | $676.08 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $933.25 / $1,737.80
| Professional | | $398.11 | $933.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $1,584.89
| Professional | TC | $562.34 | $812.83 | $1,584.89 |
- 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
- $630.96 / $1,000.00 / $6,456.54
| Professional | | $630.96 | $1,000.00 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $870.96 / $5,754.40
| Professional | TC | $575.44 | $870.96 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $912.01 / $1,548.82
| Professional | | $630.96 | $912.01 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $794.33 / $1,380.38
| Professional | TC | $575.44 | $794.33 | $1,380.38 |