- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $562.34 / $724.44
| Facility | 26 | $436.52 | $562.34 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,089.30 / $5,011.87
| Professional | | $1,621.81 | $2,089.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $1,288.25
| Professional | 26 | $354.81 | $562.34 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,258.93 / $1,621.81 / $3,235.94
| Professional | TC | $1,258.93 | $1,621.81 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,511.89 / $3,715.35
| Professional | | $1,737.80 | $2,511.89 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $562.34 / $831.76
| Professional | 26 | $398.11 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,288.25 / $1,949.84 / $2,884.03
| Professional | TC | $1,288.25 | $1,949.84 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,884.03 / $4,365.16
| Professional | | $1,737.80 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $602.56 / $933.25
| Professional | 26 | $389.05 | $602.56 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,348.96 / $2,238.72 / $3,388.44
| Professional | TC | $1,348.96 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $3,235.94 / $8,511.38
| Professional | | $2,951.21 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $676.08 / $2,290.87
| Professional | 26 | $616.60 | $676.08 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,344.23 / $2,570.40 / $6,165.95
| Professional | TC | $2,344.23 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,041.74 / $2,089.30
| Professional | | $1,737.80 | $2,041.74 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $426.58 / $426.58
| Professional | 26 | $407.38 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,318.26 / $1,621.81 / $1,621.81
| Professional | TC | $1,318.26 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,884.03 / $4,570.88
| Professional | | $2,137.96 | $2,884.03 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,122.02
| Professional | 26 | $478.63 | $691.83 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $2,187.76 / $3,388.44
| Professional | TC | $1,479.11 | $2,187.76 | $3,388.44 |