- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $70.79 / $117.49
| Facility | 26 | $64.57 | $70.79 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $831.76 / $1,412.54
| Professional | | $691.83 | $831.76 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $758.58 / $1,288.25
| Professional | TC | $602.56 | $758.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $724.44 / $933.25
| Professional | | $83.18 | $724.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $1,023.29 / $1,905.46
| Professional | | $588.84 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $891.25 / $1,698.24
| Professional | TC | $512.86 | $891.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 26 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $7,943.28 / $7,943.28
| Professional | | $6,456.54 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5,754.40 / $7,079.46 / $7,079.46
| Professional | TC | $5,754.40 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $131.83
| Facility | 26 | $67.61 | $93.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,348.96 / $2,238.72
| Professional | | $707.95 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $1,202.26 / $2,041.74
| Professional | TC | $630.96 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $75.86
| Professional | | $32.36 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,445.44 / $1,995.26
| Professional | | $1,122.02 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $1,023.29 / $1,905.46
| Professional | | $602.56 | $1,023.29 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $891.25 / $1,819.70
| Professional | TC | $524.81 | $891.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $851.14 / $1,288.25
| Professional | | $645.65 | $851.14 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $741.31 / $1,148.15
| Professional | TC | $537.03 | $741.31 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,023.29 / $1,023.29
| Professional | | $977.24 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $891.25 / $933.25 / $933.25
| Professional | TC | $891.25 | $933.25 | $933.25 |