- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | 26 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $1,288.25
| Professional | | $316.23 | $457.09 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $154.88 / $478.63
| Professional | 26 | $114.82 | $154.88 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $794.33
| Professional | TC | $186.21 | $309.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,258.93
| Professional | | $933.25 | $933.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $537.03
| Professional | 26 | $457.09 | $457.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $724.44
| Professional | TC | $478.63 | $478.63 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | 26 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $1,148.15 / $1,479.11
| Professional | | $446.68 | $1,148.15 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $389.05 / $489.78
| Professional | 26 | $151.36 | $389.05 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $776.25 / $1,000.00
| Professional | TC | $295.12 | $776.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $3,311.31
| Professional | | $1,862.09 | $1,862.09 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $562.34 / $616.60 / $1,318.26
| Professional | 26 | $562.34 | $616.60 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,174.90 / $1,258.93 / $1,995.26
| Professional | TC | $1,174.90 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $1,258.93
| Professional | | $363.08 | $707.95 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $204.17 / $537.03
| Professional | 26 | $144.54 | $204.17 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $724.44
| Professional | TC | $218.78 | $309.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,513.56 / $5,754.40
| Professional | | $524.81 | $1,513.56 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $645.65 / $2,454.71
| Professional | 26 | $223.87 | $645.65 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $870.96 / $3,311.31
| Professional | TC | $302.00 | $870.96 | $3,311.31 |