- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $562.34
| Facility | 26 | $436.52 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,174.90 / $2,511.89
| Professional | | $912.01 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $407.38 / $1,318.26
| Professional | 26 | $269.15 | $407.38 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $851.14 / $1,548.82
| Professional | TC | $630.96 | $851.14 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $263.03 / $295.12
| Professional | 26 | $245.47 | $263.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,258.93 / $7,244.36
| Professional | | $1,000.00 | $1,258.93 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $354.81 / $2,041.74
| Professional | 26 | $281.84 | $354.81 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $891.25 / $5,128.61
| Professional | TC | $707.95 | $891.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,318.26 / $1,995.26
| Professional | | $1,071.52 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $380.19 / $562.34
| Professional | 26 | $302.00 | $380.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $933.25 / $1,412.54
| Professional | TC | $758.58 | $933.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,630.27
| Facility | 26 | $2,137.96 | $2,137.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,230.27 / $6,918.31
| Professional | | $1,000.00 | $1,230.27 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $363.08 / $1,778.28
| Professional | 26 | $281.84 | $363.08 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $870.96 / $5,128.61
| Professional | TC | $707.95 | $870.96 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,148.15 / $1,778.28
| Professional | | $912.01 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $263.03 / $338.84 / $524.81
| Professional | 26 | $263.03 | $338.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $812.83 / $1,288.25
| Professional | TC | $660.69 | $812.83 | $1,288.25 |