- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $588.84 / $676.08
| Facility | 26 | $457.09 | $588.84 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,949.84 / $3,235.94
| Professional | | $1,412.54 | $1,949.84 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $436.52 / $1,348.96
| Professional | 26 | $316.23 | $436.52 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,071.52 / $1,513.56 / $2,398.83
| Professional | TC | $1,071.52 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,137.96 / $2,754.23
| Professional | | $1,862.09 | $2,137.96 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $489.78 / $630.96
| Professional | 26 | $426.58 | $489.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $1,621.81 / $2,089.30
| Professional | TC | $1,412.54 | $1,621.81 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,884.03 / $3,801.89
| Professional | | $954.99 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,691.53 / $3,467.37
| Professional | | $1,659.59 | $2,691.53 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $549.54 / $831.76
| Professional | 26 | $354.81 | $549.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,258.93 / $2,089.30 / $3,090.30
| Professional | TC | $1,258.93 | $2,089.30 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,388.44 / $3,801.89 / $3,981.07
| Professional | | $3,388.44 | $3,801.89 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $602.56 / $616.60 / $831.76
| Professional | 26 | $602.56 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,691.53 / $2,691.53 / $2,691.53
| Professional | TC | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $3,388.44
| Professional | | $1,548.82 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $812.83
| Professional | 26 | $380.19 | $467.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,288.25 / $1,621.81 / $2,570.40
| Professional | TC | $1,288.25 | $1,621.81 | $2,570.40 |