- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $323.59 / $954.99
| Facility | 26 | $229.09 | $323.59 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,000.00 / $6,025.60
| Professional | | $691.83 | $1,000.00 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $891.25 / $5,495.41
| Professional | TC | $588.84 | $891.25 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $1,698.24 / $1,778.28
| Professional | | $1,584.89 | $1,698.24 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $1,479.11 / $1,584.89
| Professional | TC | $691.83 | $1,479.11 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 26 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,089.30 / $2,951.21
| Professional | | $1,318.26 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,174.90 / $1,905.46 / $2,630.27
| Professional | TC | $1,174.90 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | 26 | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,174.90 / $6,456.54
| Professional | | $575.44 | $1,174.90 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $1,000.00 / $5,754.40
| Professional | TC | $616.60 | $1,000.00 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,995.26 / $3,162.28
| Professional | | $1,737.80 | $1,995.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $213.80 / $338.84
| Professional | 26 | $181.97 | $213.80 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $1,778.28 / $2,884.03
| Professional | TC | $1,479.11 | $1,778.28 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Facility | 26 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $2,089.30 / $2,238.72
| Professional | | $2,089.30 | $2,089.30 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $1,995.26
| Professional | TC | $1,862.09 | $1,862.09 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,737.80 / $1,949.84
| Professional | | $724.44 | $1,737.80 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $1,548.82 / $1,778.28
| Professional | TC | $616.60 | $1,548.82 | $1,778.28 |