- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $120.23 / $288.40
| Facility | 26 | $89.13 | $120.23 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $1,548.82
| Professional | | $707.95 | $870.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $97.72 / $257.04
| Professional | 26 | $81.28 | $97.72 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,380.38
| Professional | TC | $630.96 | $776.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $794.33 / $1,778.28
| Professional | | $120.23 | $794.33 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,148.15 / $1,737.80
| Professional | | $707.95 | $1,148.15 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $134.90 / $213.80
| Professional | 26 | $81.28 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $1,023.29 / $1,659.59
| Professional | TC | $660.69 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,202.26 / $5,370.32
| Professional | | $724.44 | $1,202.26 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $562.34
| Professional | 26 | $97.72 | $138.04 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $3,548.13
| Professional | TC | $691.83 | $977.24 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $954.99 / $1,047.13
| Professional | | $933.25 | $954.99 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $117.49 / $125.89
| Professional | 26 | $107.15 | $117.49 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $776.25 / $812.83 / $912.01
| Professional | TC | $776.25 | $812.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,202.26 / $1,737.80
| Professional | | $851.14 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $131.83 / $194.98
| Professional | 26 | $95.50 | $131.83 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $1,071.52 / $1,548.82
| Professional | TC | $758.58 | $1,071.52 | $1,548.82 |