- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $457.09 / $1,445.44
| Facility | 26 | $269.15 | $457.09 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,995.26 / $4,786.30
| Professional | | $1,258.93 | $1,995.26 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $467.74 / $1,174.90
| Professional | 26 | $281.84 | $467.74 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $1,513.56 / $2,754.23
| Professional | TC | $933.25 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,584.89 / $2,818.38
| Professional | | $1,380.38 | $1,584.89 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $512.86 / $724.44
| Professional | 26 | $323.59 | $512.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $1,548.82 / $1,862.09
| Professional | | $1,258.93 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $478.63 / $691.83
| Facility | 26 | $102.33 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $3,548.13
| Professional | | $1,412.54 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $776.25
| Professional | 26 | $331.13 | $501.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,819.70 / $2,884.03
| Professional | TC | $1,148.15 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,412.54 / $2,187.76
| Professional | | $1,318.26 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $309.03 / $478.63
| Professional | 26 | $295.12 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,047.13 / $1,122.02 / $1,698.24
| Professional | TC | $1,047.13 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $851.14 / $2,089.30
| Professional | | $32.36 | $851.14 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,995.26 / $3,388.44
| Professional | | $1,479.11 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $426.58 / $741.31
| Professional | 26 | $323.59 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,584.89 / $2,630.27
| Professional | TC | $1,148.15 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,995.26
| Professional | | $1,318.26 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $426.58
| Professional | 26 | $302.00 | $302.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,584.89
| Professional | TC | $1,023.29 | $1,023.29 | $1,584.89 |