- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $616.60
| Facility | 26 | $288.40 | $380.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,202.26 / $2,511.89
| Professional | | $977.24 | $1,202.26 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $912.01
| Professional | 26 | $269.15 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $1,548.82
| Professional | TC | $676.08 | $851.14 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,584.89 / $3,235.94
| Professional | | $891.25 | $1,584.89 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $446.68 / $851.14
| Professional | 26 | $281.84 | $446.68 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $1,122.02 / $2,344.23
| Professional | TC | $630.96 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $416.87 / $1,995.26
| Facility | 26 | $70.79 | $416.87 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,659.59 / $3,388.44
| Professional | | $1,122.02 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $489.78 / $933.25
| Professional | 26 | $323.59 | $489.78 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,202.26 / $2,454.71
| Professional | TC | $794.33 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,412.54 / $2,630.27
| Professional | | $954.99 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $724.44
| Professional | 26 | $275.42 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $1,000.00 / $1,862.09
| Professional | TC | $691.83 | $1,000.00 | $1,862.09 |