- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $275.42
| Facility | 26 | $104.71 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $524.81 / $1,621.81
| Professional | | $354.81 | $524.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $380.19
| Professional | 26 | $107.15 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $724.44
| Professional | TC | $239.88 | $338.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $123.03 / $177.83
| Facility | 26 | $26.92 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $660.69 / $1,318.26
| Professional | | $338.84 | $660.69 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $154.88 / $316.23
| Professional | 26 | $107.15 | $154.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $457.09 / $1,000.00
| Professional | TC | $229.09 | $457.09 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $724.44 / $870.96
| Professional | | $630.96 | $724.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $234.42 / $281.84
| Professional | 26 | $199.53 | $234.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $489.78 / $602.56
| Professional | TC | $426.58 | $489.78 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $218.78 / $275.42
| Facility | 26 | $104.71 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $724.44 / $1,230.27
| Professional | | $524.81 | $724.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $223.87 / $338.84
| Professional | 26 | $141.25 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $1,122.02
| Professional | TC | $338.84 | $489.78 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $281.84 / $645.65
| Professional | | $154.88 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $741.31 / $1,148.15
| Professional | | $363.08 | $741.31 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $223.87 / $316.23
| Professional | 26 | $107.15 | $223.87 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $549.54 / $1,148.15
| Professional | TC | $229.09 | $549.54 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 26 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $776.25 / $1,000.00
| Professional | | $630.96 | $776.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $199.53 / $229.09 / $309.03
| Professional | 26 | $199.53 | $229.09 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $524.81 / $676.08
| Professional | TC | $416.87 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $691.83 / $1,230.27
| Professional | | $316.23 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $331.13
| Professional | 26 | $97.72 | $144.54 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $467.74 / $1,000.00
| Professional | TC | $218.78 | $467.74 | $1,000.00 |