- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $208.93 / $602.56
| Facility | 26 | $85.11 | $208.93 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $794.33 / $1,318.26
| Professional | | $676.08 | $794.33 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $776.25
| Professional | 26 | $64.57 | $85.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $707.95 / $1,174.90
| Professional | TC | $602.56 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,148.15 / $1,621.81
| Professional | | $891.25 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $812.83 / $812.83 / $812.83
| Professional | TC | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,187.76 / $4,677.35
| Professional | | $954.99 | $2,187.76 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $154.88 / $467.74
| Professional | 26 | $81.28 | $154.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $870.96 / $1,995.26 / $4,265.80
| Professional | TC | $870.96 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,023.29 / $1,949.84
| Professional | | $870.96 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $112.20 / $208.93
| Professional | 26 | $97.72 | $112.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $776.25 / $912.01 / $1,778.28
| Professional | TC | $776.25 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,380.38 / $2,951.21
| Professional | | $812.83 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $138.04 / $316.23
| Professional | 26 | $79.43 | $138.04 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,258.93 / $2,630.27
| Professional | TC | $724.44 | $1,258.93 | $2,630.27 |