- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $870.96 / $1,202.26 / $3,630.78
| Facility | 26 | $870.96 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $4,265.80 / $10,964.78
| Professional | | $1,905.46 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $912.01 / $2,041.74
| Professional | 26 | $398.11 | $912.01 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,318.26 / $2,818.38 / $9,332.54
| Professional | TC | $1,318.26 | $2,818.38 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,570.88 / $4,570.88 / $4,570.88
| Professional | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $812.83 / $1,000.00
| Professional | 26 | $478.63 | $812.83 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,090.30 / $3,388.44 / $3,467.37
| Professional | | $3,090.30 | $3,388.44 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $724.44 / $776.25 / $812.83
| Professional | 26 | $724.44 | $776.25 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,348.96 / $2,511.89 / $2,691.53
| Professional | TC | $1,348.96 | $2,511.89 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 26 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $4,265.80 / $5,623.41
| Professional | | $2,951.21 | $4,265.80 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $588.84 / $977.24 / $1,258.93
| Professional | 26 | $588.84 | $977.24 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,398.83 / $3,311.31 / $4,365.16
| Professional | TC | $2,398.83 | $3,311.31 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $891.25 / $1,905.46 / $1,905.46
| Facility | 26 | $891.25 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $3,235.94 / $13,489.63
| Professional | | $2,137.96 | $3,235.94 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $776.25 / $2,818.38
| Professional | 26 | $478.63 | $776.25 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,659.59 / $2,187.76 / $8,912.51
| Professional | TC | $1,659.59 | $2,187.76 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $3,981.07 / $6,309.57
| Professional | | $3,467.37 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $812.83 / $912.01 / $1,445.44
| Professional | 26 | $812.83 | $912.01 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,691.53 / $3,019.95 / $4,897.79
| Professional | TC | $2,691.53 | $3,019.95 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 26 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,168.69 / $4,168.69 / $4,466.84
| Professional | | $4,168.69 | $4,168.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $1,047.13
| Professional | 26 | $954.99 | $954.99 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3,162.28 / $3,162.28 / $3,388.44
| Professional | TC | $3,162.28 | $3,162.28 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,467.37 / $4,677.35
| Professional | | $2,344.23 | $3,467.37 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $794.33 / $1,071.52
| Professional | 26 | $478.63 | $794.33 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,778.28 / $2,630.27 / $3,548.13
| Professional | TC | $1,778.28 | $2,630.27 | $3,548.13 |