- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $245.47
| Facility | 26 | $123.03 | $208.93 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,047.13 / $2,691.53
| Professional | | $776.25 | $1,047.13 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $912.01 / $2,454.71
| Professional | TC | $691.83 | $912.01 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,862.09 / $2,818.38
| Professional | | $1,202.26 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,047.13 / $1,659.59 / $2,511.89
| Professional | TC | $1,047.13 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,398.83 / $2,630.27
| Professional | | $1,995.26 | $2,398.83 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $251.19
| Professional | 26 | $194.98 | $234.42 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,778.28 / $2,137.96 / $2,398.83
| Professional | TC | $1,778.28 | $2,137.96 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $245.47
| Facility | 26 | $123.03 | $208.93 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,949.84 / $3,162.28
| Professional | | $1,023.29 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $1,995.26 / $2,691.53
| Professional | TC | $741.31 | $1,995.26 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $229.09 / $1,479.11
| Professional | | $117.49 | $229.09 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,862.09 / $2,754.23
| Professional | | $1,202.26 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $977.24 / $1,548.82 / $2,454.71
| Professional | TC | $977.24 | $1,548.82 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 26 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,089.30 / $2,691.53
| Professional | | $1,698.24 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,513.56 / $1,905.46 / $2,454.71
| Professional | TC | $1,513.56 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $1,071.52 / $2,511.89
| Professional | | $676.08 | $1,071.52 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $954.99 / $2,238.72
| Professional | TC | $549.54 | $954.99 | $2,238.72 |