- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $870.96
| Facility | 26 | $302.00 | $426.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $416.87 / $1,348.96
| Professional | | $275.42 | $416.87 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $114.82 / $338.84
| Professional | 26 | $74.13 | $114.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $812.83
| Professional | TC | $204.17 | $295.12 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $912.01 / $1,202.26
| Professional | | $501.19 | $912.01 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $331.13
| Professional | 26 | $79.43 | $186.21 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $645.65 / $891.25
| Professional | TC | $371.54 | $645.65 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $933.25
| Facility | 26 | $302.00 | $426.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $912.01 / $2,187.76
| Professional | | $389.05 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $275.42 / $691.83
| Professional | 26 | $97.72 | $275.42 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $1,479.11
| Professional | TC | $323.59 | $660.69 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,412.54 / $2,238.72
| Professional | | $1,318.26 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $380.19 / $630.96
| Professional | 26 | $346.74 | $380.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $912.01 / $1,047.13 / $1,621.81
| Professional | TC | $912.01 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $870.96 / $1,096.48
| Professional | | $537.03 | $870.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $186.21 / $323.59
| Professional | 26 | $79.43 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $645.65 / $776.25
| Professional | TC | $245.47 | $645.65 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $891.25 / $2,137.96
| Professional | | $389.05 | $891.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $281.84 / $676.08
| Professional | 26 | $104.71 | $281.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $602.56 / $1,445.44
| Professional | TC | $302.00 | $602.56 | $1,445.44 |