- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $1,148.15 / $2,691.53
| Facility | 26 | $380.19 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $2,041.74 / $6,309.57
| Professional | | $1,348.96 | $2,041.74 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $537.03 / $1,380.38
| Professional | 26 | $309.03 | $537.03 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,047.13 / $1,778.28 / $4,677.35
| Professional | TC | $1,047.13 | $1,778.28 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $4,466.84 / $8,511.38
| Professional | | $1,659.59 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | 26 | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,454.71 / $7,413.10
| Professional | | $1,698.24 | $2,454.71 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $616.60 / $1,548.82
| Professional | 26 | $363.08 | $616.60 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,318.26 / $1,862.09 / $5,888.44
| Professional | TC | $1,318.26 | $1,862.09 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,511.89 / $4,365.16
| Professional | | $2,187.76 | $2,511.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $933.25
| Professional | 26 | $436.52 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,737.80 / $1,995.26 / $3,467.37
| Professional | TC | $1,737.80 | $1,995.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,818.38 / $6,165.95
| Professional | | $1,698.24 | $2,818.38 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $575.44 / $1,318.26
| Professional | 26 | $309.03 | $575.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $4,897.79
| Professional | TC | $1,412.54 | $2,238.72 | $4,897.79 |