- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $2,137.96
| Facility | 26 | $416.87 | $549.54 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $2,041.74 / $5,248.07
| Professional | | $1,380.38 | $2,041.74 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $1,122.02
| Professional | 26 | $354.81 | $467.74 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,047.13 / $1,513.56 / $2,344.23
| Professional | TC | $1,047.13 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,819.70 / $3,467.37
| Professional | | $1,737.80 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $407.38 / $741.31
| Professional | 26 | $323.59 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,380.38 / $1,412.54 / $3,548.13
| Professional | | $1,380.38 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $977.24
| Professional | 26 | $407.38 | $602.56 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,445.44 / $2,238.72 / $3,388.44
| Professional | TC | $1,445.44 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | 26 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,454.71 / $3,981.07
| Professional | | $1,659.59 | $2,454.71 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $588.84 / $851.14
| Professional | 26 | $407.38 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $3,019.95
| Professional | TC | $1,230.27 | $1,905.46 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | 26 | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14,125.38 / $15,488.17 / $15,488.17
| Professional | | $14,125.38 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,951.21 / $3,467.37 / $3,467.37
| Professional | 26 | $2,951.21 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9,332.54 / $12,302.69 / $12,302.69
| Professional | TC | $9,332.54 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,584.89 / $2,137.96 / $3,548.13
| Professional | | $1,584.89 | $2,137.96 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $794.33
| Professional | 26 | $398.11 | $467.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,096.48 / $1,659.59 / $2,691.53
| Professional | TC | $1,096.48 | $1,659.59 | $2,691.53 |