- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $269.15 / $537.03
| Professional | | $213.80 | $269.15 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $251.19
| Professional | 26 | $87.10 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $275.42
| Professional | TC | $100.00 | $131.83 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $95.50 / $95.50
| Facility | 26 | $79.43 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,047.13 / $1,513.56
| Professional | | $691.83 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $407.38
| Professional | 26 | $186.21 | $281.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $812.83 / $1,096.48
| Professional | TC | $512.86 | $812.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $407.38 / $1,000.00
| Facility | 26 | $186.21 | $407.38 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $812.83 / $1,288.25
| Professional | | $478.63 | $812.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $213.80 / $354.81
| Professional | 26 | $120.23 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $602.56 / $933.25
| Professional | TC | $346.74 | $602.56 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $323.59 / $398.11 / $794.33
| Facility | 26 | $323.59 | $398.11 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $645.65 / $1,071.52
| Professional | | $645.65 | $645.65 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $302.00
| Professional | 26 | $169.82 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $776.25
| Professional | TC | $467.74 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $776.25 / $1,905.46
| Professional | | $436.52 | $776.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $204.17 / $724.44
| Professional | 26 | $117.49 | $204.17 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $602.56 / $1,445.44
| Professional | TC | $331.13 | $602.56 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $758.58 / $1,380.38
| Professional | | $407.38 | $758.58 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $354.81 / $933.25
| Professional | 26 | $100.00 | $354.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $1,047.13
| Professional | TC | $302.00 | $575.44 | $1,047.13 |