- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $645.65 / $1,621.81
| Facility | 26 | $380.19 | $645.65 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,137.96 / $3,630.78
| Professional | | $1,548.82 | $2,137.96 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $467.74 / $891.25
| Professional | 26 | $354.81 | $467.74 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,202.26 / $1,737.80 / $2,691.53
| Professional | TC | $1,202.26 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,819.70 / $2,691.53 / $3,890.45
| Professional | | $1,819.70 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $933.25
| Professional | 26 | $416.87 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $2,089.30 / $2,884.03
| Professional | TC | $1,412.54 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $2,089.30 / $5,495.41
| Professional | | $691.83 | $2,089.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $457.09 / $691.83
| Professional | 26 | $407.38 | $457.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,096.48 / $1,479.11 / $2,511.89
| Professional | TC | $1,096.48 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,479.11 / $2,344.23 / $3,890.45
| Professional | | $1,479.11 | $2,344.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $851.14
| Professional | 26 | $338.84 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,949.84 / $3,162.28
| Professional | TC | $1,148.15 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $2,630.27 / $2,884.03
| Professional | | $1,949.84 | $2,630.27 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $616.60
| Professional | 26 | $416.87 | $549.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,548.82 / $2,041.74 / $2,238.72
| Professional | TC | $1,548.82 | $2,041.74 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,238.72 / $2,630.27
| Professional | | $1,905.46 | $2,238.72 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $562.34 / $602.56 / $707.95
| Professional | 26 | $562.34 | $602.56 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,951.21 / $2,951.21 / $2,951.21
| Professional | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $2,187.76 / $8,128.31
| Professional | | $512.86 | $2,187.76 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $1,000.00
| Professional | 26 | $407.38 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,348.96 / $1,995.26 / $3,467.37
| Professional | TC | $1,348.96 | $1,995.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,344.23 / $4,073.80
| Professional | | $1,548.82 | $2,344.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $512.86 / $776.25
| Professional | 26 | $331.13 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,202.26 / $1,819.70 / $3,162.28
| Professional | TC | $1,202.26 | $1,819.70 | $3,162.28 |