- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $537.03 / $1,995.26
| Facility | 26 | $371.54 | $537.03 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,511.89 / $9,772.37
| Professional | | $1,819.70 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $660.69 / $1,995.26
| Professional | 26 | $371.54 | $660.69 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $2,089.30 / $7,762.47
| Professional | TC | $1,479.11 | $2,089.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,290.87 / $4,786.30
| Professional | | $1,659.59 | $2,290.87 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $630.96 / $1,023.29
| Professional | 26 | $363.08 | $630.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,445.44 / $1,445.44 / $1,445.44
| Professional | TC | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,818.38 / $6,309.57
| Professional | | $1,862.09 | $2,818.38 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $575.44 / $1,202.26
| Professional | 26 | $426.58 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $5,128.61
| Professional | TC | $1,412.54 | $2,238.72 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,818.38 / $6,606.93
| Professional | | $1,949.84 | $2,818.38 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $1,230.27
| Professional | 26 | $346.74 | $501.19 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,584.89 / $2,344.23 / $5,370.32
| Professional | TC | $1,584.89 | $2,344.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,511.89 / $5,128.61
| Professional | | $1,659.59 | $2,511.89 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $1,071.52
| Professional | 26 | $354.81 | $512.86 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,288.25 / $2,041.74 / $4,265.80
| Professional | TC | $1,288.25 | $2,041.74 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,630.27 / $3,630.78
| Professional | | $1,230.27 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $501.19 / $676.08
| Professional | 26 | $245.47 | $501.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,000.00 / $2,137.96 / $2,951.21
| Professional | TC | $1,000.00 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,511.89 / $4,677.35
| Professional | | $1,949.84 | $2,511.89 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $588.84 / $1,000.00
| Professional | 26 | $426.58 | $588.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,698.24 / $2,398.83 / $4,073.80
| Professional | TC | $1,698.24 | $2,398.83 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | 26 | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $15,488.17 / $15,488.17
| Professional | | $14,125.38 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,951.21 / $3,467.37 / $3,467.37
| Professional | 26 | $2,951.21 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9,332.54 / $12,302.69 / $12,302.69
| Professional | TC | $9,332.54 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $489.78 / $2,041.74
| Professional | | $32.36 | $489.78 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | 26 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,511.89 / $5,011.87
| Professional | | $1,659.59 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $1,047.13
| Professional | 26 | $354.81 | $501.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,288.25 / $1,995.26 / $4,265.80
| Professional | TC | $1,288.25 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,456.54 / $6,456.54 / $6,456.54
| Professional | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Professional | 26 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5,011.87 / $5,011.87 / $5,011.87
| Professional | TC | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,230.27 / $2,089.30 / $2,454.71
| Professional | | $1,230.27 | $2,089.30 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,454.71 / $5,370.32
| Professional | | $1,513.56 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $537.03 / $1,122.02
| Professional | 26 | $309.03 | $537.03 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $4,265.80
| Professional | TC | $1,230.27 | $1,905.46 | $4,265.80 |