- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 26 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,089.30 / $7,413.10
| Professional | | $1,380.38 | $2,089.30 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $457.09 / $1,202.26
| Professional | 26 | $407.38 | $457.09 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,071.52 / $1,621.81 / $6,309.57
| Professional | TC | $1,071.52 | $1,621.81 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,248.07 / $5,248.07 / $5,754.40
| Professional | | $5,248.07 | $5,248.07 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,258.93 / $1,258.93 / $1,479.11
| Professional | 26 | $1,258.93 | $1,258.93 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3,981.07 / $3,981.07 / $4,265.80
| Professional | TC | $3,981.07 | $3,981.07 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 26 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,897.79 / $6,309.57
| Professional | | $2,041.74 | $4,897.79 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $1,047.13 / $1,479.11
| Professional | 26 | $416.87 | $1,047.13 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,584.89 / $3,890.45 / $5,011.87
| Professional | TC | $1,584.89 | $3,890.45 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,413.10 / $7,413.10 / $16,982.44
| Professional | | $7,413.10 | $7,413.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,584.89 / $1,698.24 / $3,630.78
| Professional | 26 | $1,584.89 | $1,698.24 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5,754.40 / $5,754.40 / $13,182.57
| Professional | TC | $5,754.40 | $5,754.40 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $3,890.45 / $5,754.40
| Professional | | $1,819.70 | $3,890.45 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $1,479.11
| Professional | 26 | $398.11 | $562.34 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,445.44 / $2,041.74 / $4,265.80
| Professional | TC | $1,445.44 | $2,041.74 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $6,918.31 / $26,302.68
| Professional | | $2,818.38 | $6,918.31 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $1,778.28 / $6,760.83
| Professional | 26 | $537.03 | $1,778.28 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,290.87 / $5,128.61 / $19,498.45
| Professional | TC | $2,290.87 | $5,128.61 | $19,498.45 |