- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $489.78 / $512.86
| Facility | 26 | $363.08 | $489.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,630.27 / $9,120.11
| Professional | | $1,584.89 | $2,630.27 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $676.08 / $1,949.84
| Professional | 26 | $371.54 | $676.08 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,949.84 / $4,897.79
| Professional | TC | $1,148.15 | $1,949.84 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,905.46 / $2,187.76
| Professional | | $524.81 | $1,905.46 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $389.05 / $457.09 / $467.74
| Professional | 26 | $389.05 | $457.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,862.09
| Professional | TC | $1,479.11 | $1,479.11 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,187.76 / $5,011.87
| Professional | | $1,479.11 | $2,187.76 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $1,122.02
| Professional | 26 | $331.13 | $446.68 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,737.80 / $3,890.45
| Professional | TC | $1,148.15 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,398.83 / $4,073.80
| Professional | | $1,995.26 | $2,398.83 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $478.63 / $891.25
| Professional | 26 | $416.87 | $478.63 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,584.89 / $1,905.46 / $3,311.31
| Professional | TC | $1,584.89 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $1,949.84 / $3,548.13
| Professional | | $1,479.11 | $1,949.84 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $302.00 / $407.38 / $758.58
| Professional | 26 | $302.00 | $407.38 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,174.90 / $1,584.89 / $2,818.38
| Professional | TC | $1,174.90 | $1,584.89 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,398.83 / $3,019.95
| Professional | | $1,584.89 | $2,398.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $645.65
| Professional | 26 | $346.74 | $501.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $2,398.83
| Professional | TC | $1,230.27 | $1,905.46 | $2,398.83 |