- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | 26 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $407.38 / $812.83
| Professional | | $316.23 | $407.38 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $346.74 / $616.60
| Professional | TC | $263.03 | $346.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $50.12
| Facility | 26 | $41.69 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,047.13 / $1,513.56
| Professional | | $616.60 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $537.03 / $977.24 / $1,288.25
| Professional | TC | $537.03 | $977.24 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $489.78
| Facility | 26 | $147.91 | $208.93 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $1,174.90 / $1,819.70
| Professional | | $660.69 | $1,174.90 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $1,023.29 / $1,584.89
| Professional | TC | $588.84 | $1,023.29 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $389.05
| Facility | 26 | $158.49 | $199.53 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,071.52 / $1,659.59
| Professional | | $724.44 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $933.25 / $1,445.44
| Professional | TC | $630.96 | $933.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $741.31 / $2,691.53
| Professional | | $363.08 | $741.31 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $645.65 / $2,344.23
| Professional | TC | $309.03 | $645.65 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $831.76 / $1,412.54
| Professional | | $380.19 | $831.76 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $707.95 / $1,258.93
| Professional | TC | $323.59 | $707.95 | $1,258.93 |