- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $537.03 / $602.56 / $758.58
| Facility | 26 | $537.03 | $602.56 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,137.96 / $10,715.19
| Professional | | $1,621.81 | $2,137.96 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $1,949.84
| Professional | 26 | $346.74 | $562.34 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,122.02 / $1,698.24 / $8,511.38
| Professional | TC | $1,122.02 | $1,698.24 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $1,258.93 / $2,137.96
| Professional | | $302.00 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,818.38 / $3,548.13
| Professional | | $1,905.46 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $602.56 / $794.33
| Professional | 26 | $457.09 | $602.56 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $2,818.38
| Professional | TC | $1,412.54 | $2,238.72 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $1,288.25
| Professional | | $32.36 | $33.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $2,818.38 / $3,548.13
| Professional | | $1,737.80 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $457.09 / $602.56 / $794.33
| Professional | 26 | $457.09 | $602.56 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $2,238.72 / $2,818.38
| Professional | TC | $1,412.54 | $2,238.72 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,454.71 / $2,630.27 / $3,801.89
| Professional | | $2,454.71 | $2,630.27 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $478.63 / $512.86 / $851.14
| Professional | 26 | $478.63 | $512.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,905.46 / $2,089.30 / $2,951.21
| Professional | TC | $1,905.46 | $2,089.30 | $2,951.21 |