- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $218.78
| Facility | 26 | $95.50 | $162.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $524.81 / $2,691.53
| Professional | | $234.42 | $524.81 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $177.83 / $524.81
| Professional | 26 | $97.72 | $177.83 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $1,122.02
| Professional | TC | $295.12 | $398.11 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $1,000.00 / $1,348.96
| Professional | | $562.34 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $239.88 / $295.12
| Professional | 26 | $102.33 | $239.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $776.25 / $1,122.02
| Professional | TC | $416.87 | $776.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $707.95 / $2,630.27
| Professional | | $371.54 | $707.95 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $186.21 / $537.03
| Professional | 26 | $95.50 | $186.21 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $537.03 / $2,137.96
| Professional | TC | $281.84 | $537.03 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $741.31 / $954.99 / $954.99
| Facility | 26 | $741.31 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $1,000.00 / $6,025.60
| Professional | | $537.03 | $1,000.00 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $676.08
| Professional | 26 | $104.71 | $158.49 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $691.83 / $5,495.41
| Professional | TC | $380.19 | $691.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,096.48 / $1,445.44
| Professional | | $831.76 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $251.19 / $316.23
| Professional | 26 | $204.17 | $251.19 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $831.76 / $1,202.26
| Professional | TC | $616.60 | $831.76 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Facility | 26 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,202.26 / $1,318.26
| Professional | | $977.24 | $1,202.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $190.55 / $218.78 / $309.03
| Professional | 26 | $190.55 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $1,000.00 / $1,000.00
| Professional | TC | $741.31 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $316.23 / $691.83
| Professional | | $104.71 | $316.23 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $776.25 / $2,238.72
| Professional | | $478.63 | $776.25 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $173.78 / $346.74
| Professional | 26 | $104.71 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $1,122.02
| Professional | TC | $363.08 | $602.56 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,096.48
| Professional | | $933.25 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $269.15
| Professional | 26 | $229.09 | $229.09 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $812.83
| Professional | TC | $691.83 | $691.83 | $812.83 |