- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $1,380.38
| Facility | 26 | $407.38 | $660.69 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,238.72 / $9,549.93
| Professional | | $1,513.56 | $2,238.72 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $1,230.27
| Professional | 26 | $371.54 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,819.70 / $4,466.84
| Professional | TC | $1,122.02 | $1,819.70 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $316.23 / $323.59 / $676.08
| Professional | 26 | $316.23 | $323.59 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,187.76 / $3,548.13
| Professional | | $1,737.80 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $512.86 / $794.33
| Professional | 26 | $407.38 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,348.96 / $1,698.24 / $2,884.03
| Professional | TC | $1,348.96 | $1,698.24 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,137.96 / $3,090.30
| Professional | | $1,995.26 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $446.68 / $467.74 / $707.95
| Professional | 26 | $446.68 | $467.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,513.56 / $1,659.59 / $2,398.83
| Professional | TC | $1,513.56 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,344.23 / $3,548.13
| Professional | | $1,621.81 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $812.83
| Professional | 26 | $398.11 | $549.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,258.93 / $1,949.84 / $3,019.95
| Professional | TC | $1,258.93 | $1,949.84 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $977.24 / $1,905.46 / $1,905.46
| Facility | 26 | $977.24 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,398.83 / $13,489.63
| Professional | | $1,659.59 | $2,398.83 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $512.86 / $2,818.38
| Professional | 26 | $380.19 | $512.86 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,819.70 / $8,912.51
| Professional | TC | $1,230.27 | $1,819.70 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,137.96 / $3,630.78
| Professional | | $1,621.81 | $2,137.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $812.83
| Professional | 26 | $380.19 | $467.74 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,659.59 / $2,818.38
| Professional | TC | $1,230.27 | $1,659.59 | $2,818.38 |