- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $446.68
| Facility | 26 | $295.12 | $346.74 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,096.48 / $2,187.76
| Professional | | $1,023.29 | $1,096.48 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $363.08 / $707.95
| Professional | 26 | $263.03 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $794.33 / $1,698.24
| Professional | TC | $724.44 | $794.33 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $371.54
| Professional | 26 | $257.04 | $257.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,000.00 / $3,162.28
| Professional | | $933.25 | $1,000.00 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $575.44 / $851.14
| Professional | 26 | $275.42 | $575.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $707.95 / $1,318.26
| Professional | TC | $660.69 | $707.95 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,412.54 / $2,344.23
| Professional | | $1,096.48 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $660.69
| Professional | 26 | $331.13 | $416.87 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $1,659.59
| Professional | TC | $758.58 | $954.99 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,348.96 / $1,949.84
| Professional | | $1,000.00 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $380.19 / $616.60
| Professional | 26 | $288.40 | $380.19 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $933.25 / $1,348.96
| Professional | TC | $707.95 | $933.25 | $1,348.96 |