- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $1,862.09 / $2,630.27
| Facility | 26 | $616.60 | $1,862.09 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,511.89 / $8,709.64
| Professional | | $1,548.82 | $2,511.89 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $645.65 / $1,819.70
| Professional | 26 | $371.54 | $645.65 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,949.84 / $6,309.57
| Professional | TC | $1,230.27 | $1,949.84 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $3,019.95 / $4,466.84
| Professional | | $1,905.46 | $3,019.95 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $1,023.29
| Professional | 26 | $407.38 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $2,398.83 / $3,467.37
| Professional | TC | $1,479.11 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,691.53 / $4,897.79
| Professional | | $1,905.46 | $2,691.53 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $602.56 / $977.24
| Professional | 26 | $478.63 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $2,137.96 / $4,073.80
| Professional | TC | $1,412.54 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,454.71 / $2,691.53
| Professional | | $1,819.70 | $2,454.71 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $457.09 / $575.44
| Professional | 26 | $371.54 | $457.09 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,698.24 / $1,995.26 / $2,238.72
| Professional | TC | $1,698.24 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $776.25 / $1,000.00
| Professional | | $741.31 | $776.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,511.89 / $4,466.84
| Professional | | $1,698.24 | $2,511.89 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $549.54 / $954.99
| Professional | 26 | $371.54 | $549.54 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,348.96 / $1,995.26 / $3,630.78
| Professional | TC | $1,348.96 | $1,995.26 | $3,630.78 |