- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $2,691.53
| Facility | 26 | $380.19 | $562.34 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,238.72 / $4,265.80
| Professional | | $1,621.81 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $512.86 / $1,071.52
| Professional | 26 | $363.08 | $512.86 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,737.80 / $3,630.78
| Professional | TC | $1,230.27 | $1,737.80 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,445.44 / $1,513.56
| Professional | | $1,412.54 | $1,445.44 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $338.84 / $380.19
| Professional | 26 | $323.59 | $338.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $954.99
| Professional | 26 | $363.08 | $602.56 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,511.89 / $4,570.88
| Professional | | $1,548.82 | $2,511.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $933.25
| Professional | 26 | $354.81 | $512.86 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,202.26 / $1,995.26 / $3,630.78
| Professional | TC | $1,202.26 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $2,691.53 / $2,818.38
| Professional | | $2,344.23 | $2,691.53 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $562.34 / $588.84
| Professional | 26 | $489.78 | $562.34 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,862.09 / $2,137.96 / $2,238.72
| Professional | TC | $1,862.09 | $2,137.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,290.87 / $4,073.80
| Professional | | $1,698.24 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $467.74 / $831.76
| Professional | 26 | $346.74 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,318.26 / $1,819.70 / $3,311.31
| Professional | TC | $1,318.26 | $1,819.70 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,137.96 / $3,981.07
| Professional | | $1,479.11 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $467.74 / $831.76
| Professional | 26 | $309.03 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,174.90 / $1,698.24 / $3,311.31
| Professional | TC | $1,174.90 | $1,698.24 | $3,311.31 |