- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $478.63
| Facility | 26 | $288.40 | $288.40 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,148.15 / $1,995.26
| Professional | | $1,023.29 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $457.09 / $707.95
| Professional | 26 | $257.04 | $457.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $851.14 / $1,445.44
| Professional | TC | $724.44 | $851.14 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,290.87 / $2,570.40
| Professional | | $1,737.80 | $2,290.87 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $501.19 / $660.69 / $741.31
| Professional | 26 | $501.19 | $660.69 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,621.81 / $1,819.70
| Professional | TC | $1,230.27 | $1,621.81 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,949.84 / $3,090.30
| Professional | | $1,479.11 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $512.86 / $831.76
| Professional | 26 | $398.11 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,096.48 / $1,412.54 / $2,290.87
| Professional | TC | $1,096.48 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,905.46 / $2,454.71
| Professional | | $1,096.48 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $537.03 / $676.08
| Professional | 26 | $309.03 | $537.03 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,348.96 / $1,778.28
| Professional | TC | $794.33 | $1,348.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,862.09 / $2,630.27
| Professional | | $1,096.48 | $1,862.09 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $707.95
| Professional | 26 | $323.59 | $512.86 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,348.96 / $1,905.46
| Professional | TC | $794.33 | $1,348.96 | $1,905.46 |