- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,047.13 / $1,230.27 / $2,238.72
| Professional | | $1,047.13 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $363.08 / $812.83
| Professional | 26 | $288.40 | $363.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $870.96 / $1,548.82
| Professional | TC | $741.31 | $870.96 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,698.24 / $3,235.94
| Professional | | $1,412.54 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $478.63 / $1,023.29
| Professional | 26 | $446.68 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $954.99 / $1,230.27 / $2,187.76
| Professional | TC | $954.99 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $3,019.95 / $6,309.57
| Professional | | $1,230.27 | $3,019.95 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $870.96 / $1,995.26
| Professional | 26 | $346.74 | $870.96 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $2,187.76 / $4,265.80
| Professional | TC | $933.25 | $2,187.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $6,025.60
| Professional | | $4,168.69 | $4,168.69 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,071.52 / $1,148.15 / $1,819.70
| Professional | 26 | $1,071.52 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,691.53 / $3,019.95 / $4,265.80
| Professional | TC | $2,691.53 | $3,019.95 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,548.82 / $3,235.94
| Professional | | $977.24 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $478.63 / $1,023.29
| Professional | 26 | $288.40 | $478.63 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $1,047.13 / $2,187.76
| Professional | TC | $691.83 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,659.59 / $4,677.35
| Professional | | $1,096.48 | $1,659.59 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $501.19 / $831.76
| Professional | 26 | $79.43 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,148.15 / $3,162.28
| Professional | TC | $794.33 | $1,148.15 | $3,162.28 |