- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $288.40 / $295.12 / $295.12
| Facility | 26 | $288.40 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,148.15 / $1,659.59
| Professional | | $1,023.29 | $1,148.15 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $776.25
| Professional | 26 | $257.04 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $851.14 / $1,258.93
| Professional | TC | $758.58 | $851.14 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Professional | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,630.27
| Professional | | $2,137.96 | $2,137.96 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $707.95
| Professional | 26 | $562.34 | $562.34 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,949.84
| Professional | TC | $1,548.82 | $1,548.82 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $1,905.46 / $6,918.31
| Professional | | $933.25 | $1,905.46 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $512.86 / $1,778.28
| Professional | 26 | $316.23 | $512.86 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,412.54 / $5,128.61
| Professional | TC | $794.33 | $1,412.54 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $2,398.83
| Professional | | $1,949.84 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $676.08
| Professional | 26 | $562.34 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,737.80
| Professional | TC | $1,380.38 | $1,380.38 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,778.28 / $2,187.76
| Professional | | $1,412.54 | $1,778.28 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $537.03 / $616.60
| Professional | 26 | $389.05 | $537.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,023.29 / $1,258.93 / $1,584.89
| Professional | TC | $1,023.29 | $1,258.93 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,949.84 / $2,754.23
| Professional | | $1,202.26 | $1,949.84 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $741.31
| Professional | 26 | $346.74 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $851.14 / $1,412.54 / $1,995.26
| Professional | TC | $851.14 | $1,412.54 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,344.23 / $2,454.71
| Professional | | $1,995.26 | $2,344.23 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $575.44 / $676.08 / $707.95
| Professional | 26 | $575.44 | $676.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $1,659.59 / $1,737.80
| Professional | TC | $1,412.54 | $1,659.59 | $1,737.80 |