- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 26 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $588.84 / $2,570.40
| Professional | | $467.74 | $588.84 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $117.49 / $269.15
| Professional | 26 | $72.44 | $117.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $2,398.83
| Professional | TC | $380.19 | $512.86 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $707.95
| Professional | | $128.82 | $128.82 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $158.49
| Facility | 26 | $128.82 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $676.08 / $1,380.38
| Professional | | $380.19 | $676.08 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $104.71 / $245.47
| Professional | 26 | $69.18 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $575.44 / $1,122.02
| Professional | TC | $309.03 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $831.76 / $1,122.02
| Professional | | $758.58 | $831.76 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $158.49
| Facility | 26 | $128.82 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $707.95 / $1,023.29
| Professional | | $436.52 | $707.95 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $117.49 / $162.18
| Professional | 26 | $77.62 | $117.49 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $575.44 / $831.76
| Professional | TC | $363.08 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $645.65 / $851.14
| Professional | | $537.03 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $107.15 / $144.54
| Professional | 26 | $97.72 | $107.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $724.44
| Professional | TC | $436.52 | $549.54 | $724.44 |