- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $354.81 / $512.86
| Facility | 26 | $338.84 | $354.81 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,258.93 / $2,754.23
| Professional | | $912.01 | $1,258.93 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $436.52 / $794.33
| Professional | 26 | $269.15 | $436.52 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $870.96 / $1,445.44
| Professional | TC | $645.65 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | 26 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,479.11 / $2,754.23
| Professional | | $1,071.52 | $1,479.11 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $630.96
| Professional | 26 | $316.23 | $389.05 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $891.25 / $1,380.38
| Professional | TC | $724.44 | $891.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,047.13 / $1,445.44
| Professional | | $954.99 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $316.23 / $426.58
| Professional | 26 | $275.42 | $316.23 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $758.58 / $1,047.13
| Professional | TC | $724.44 | $758.58 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,513.56 / $2,238.72
| Professional | | $1,023.29 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $457.09 / $660.69
| Professional | 26 | $281.84 | $457.09 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,584.89
| Professional | TC | $724.44 | $1,071.52 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,137.96 / $2,630.27 / $2,630.27
| Facility | 26 | $2,137.96 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $1,698.24 / $6,918.31
| Professional | | $954.99 | $1,698.24 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $524.81 / $1,778.28
| Professional | 26 | $275.42 | $524.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $1,174.90 / $5,128.61
| Professional | TC | $691.83 | $1,174.90 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,584.89 / $2,344.23
| Professional | | $1,000.00 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $691.83
| Professional | 26 | $288.40 | $467.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,737.80
| Professional | TC | $724.44 | $1,071.52 | $1,737.80 |