- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $630.96
| Facility | 26 | $331.13 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $537.03 / $1,737.80
| Professional | | $251.19 | $537.03 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $154.88 / $371.54
| Professional | 26 | $102.33 | $154.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $436.52 / $1,230.27
| Professional | TC | $257.04 | $436.52 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,148.15 / $1,445.44
| Professional | | $562.34 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $199.53 / $354.81
| Professional | 26 | $87.10 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $933.25 / $1,096.48
| Professional | TC | $426.58 | $933.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $630.96
| Facility | 26 | $331.13 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,071.52 / $2,454.71
| Professional | | $524.81 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $302.00 / $741.31
| Professional | 26 | $144.54 | $302.00 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $776.25 / $1,737.80
| Professional | TC | $416.87 | $776.25 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $1,698.24 / $2,818.38
| Professional | | $1,621.81 | $1,698.24 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $407.38 / $691.83
| Professional | 26 | $371.54 | $407.38 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,071.52 / $1,288.25 / $2,187.76
| Professional | TC | $1,071.52 | $1,288.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,000.00 / $1,258.93
| Professional | | $676.08 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $331.13 / $354.81
| Professional | 26 | $102.33 | $331.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $831.76 / $1,096.48
| Professional | TC | $331.13 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,288.25 / $2,511.89
| Professional | | $524.81 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $302.00 / $645.65
| Professional | 26 | $112.20 | $302.00 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $977.24 / $1,995.26
| Professional | TC | $389.05 | $977.24 | $1,995.26 |