- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $660.69
| Facility | 26 | $309.03 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,148.15 / $2,511.89
| Professional | | $977.24 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $407.38 / $741.31
| Professional | 26 | $288.40 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $870.96 / $1,778.28
| Professional | TC | $724.44 | $870.96 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $398.11 / $933.25
| Professional | 26 | $380.19 | $398.11 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $2,570.40 / $3,715.35
| Professional | | $1,000.00 | $2,570.40 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $707.95 / $1,071.52
| Professional | 26 | $288.40 | $707.95 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,819.70 / $2,630.27
| Professional | TC | $724.44 | $1,819.70 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,995.26 / $3,235.94
| Professional | | $1,288.25 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $537.03 / $851.14
| Professional | 26 | $363.08 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $912.01 / $1,445.44 / $2,398.83
| Professional | TC | $912.01 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $2,041.74 / $3,548.13
| Professional | | $1,174.90 | $2,041.74 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $588.84 / $912.01
| Professional | 26 | $323.59 | $588.84 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $812.83 / $1,479.11 / $2,398.83
| Professional | TC | $812.83 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,238.72 / $4,168.69
| Professional | | $1,479.11 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $588.84 / $1,023.29
| Professional | 26 | $389.05 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,023.29 / $1,584.89 / $2,630.27
| Professional | TC | $1,023.29 | $1,584.89 | $2,630.27 |