- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $512.86 / $1,348.96
| Professional | | $346.74 | $512.86 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $645.65
| Professional | 26 | $169.82 | $275.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $660.69
| Professional | TC | $177.83 | $269.15 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,513.56
| Professional | | $1,380.38 | $1,380.38 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $676.08 / $676.08 / $794.33
| Professional | 26 | $676.08 | $676.08 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $741.31
| Professional | TC | $724.44 | $724.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $707.95 / $707.95
| Facility | 26 | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $1,174.90 / $1,513.56
| Professional | | $478.63 | $1,174.90 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $562.34 / $724.44
| Professional | 26 | $223.87 | $562.34 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $630.96 / $812.83
| Professional | TC | $269.15 | $630.96 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $4,365.16
| Professional | | $1,905.46 | $1,905.46 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $851.14 / $912.01 / $1,949.84
| Professional | 26 | $851.14 | $912.01 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $977.24 / $1,000.00 / $2,344.23
| Professional | TC | $977.24 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $1,023.29 / $1,513.56
| Professional | | $467.74 | $1,023.29 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $302.00 / $794.33
| Professional | 26 | $213.80 | $302.00 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $371.54 / $741.31
| Professional | TC | $257.04 | $371.54 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,445.44 / $6,918.31
| Professional | | $707.95 | $1,445.44 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $630.96 / $3,630.78
| Professional | 26 | $79.43 | $630.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $891.25 / $3,388.44
| Professional | TC | $371.54 | $891.25 | $3,388.44 |