- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $1,023.29
| Facility | 26 | $229.09 | $346.74 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $407.38 / $1,621.81
| Professional | | $269.15 | $407.38 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $223.87 / $288.40
| Professional | 26 | $100.00 | $223.87 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $239.88 / $602.56
| Professional | TC | $162.18 | $239.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $263.03
| Professional | 26 | $117.49 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $524.81 / $562.34
| Professional | | $501.19 | $524.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $208.93 / $223.87
| Professional | 26 | $194.98 | $208.93 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $323.59 / $338.84
| Professional | TC | $302.00 | $323.59 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 26 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $707.95 / $1,258.93
| Professional | | $323.59 | $707.95 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $97.72 / $239.88 / $323.59
| Professional | 26 | $97.72 | $239.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $501.19 / $933.25
| Professional | TC | $229.09 | $501.19 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 26 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $758.58 / $4,786.30
| Professional | | $501.19 | $758.58 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $208.93 / $1,621.81
| Professional | 26 | $138.04 | $208.93 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $588.84 / $3,630.78
| Professional | TC | $363.08 | $588.84 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $630.96 / $1,000.00
| Professional | | $549.54 | $630.96 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $380.19
| Professional | 26 | $213.80 | $245.47 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $389.05 / $616.60
| Professional | TC | $331.13 | $389.05 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Facility | 26 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $776.25 / $1,000.00
| Professional | | $616.60 | $776.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $223.87 / $380.19
| Professional | 26 | $144.54 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $616.60 / $724.44
| Professional | TC | $371.54 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $776.25 / $1,122.02
| Professional | | $501.19 | $776.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $295.12
| Professional | 26 | $131.83 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $575.44 / $776.25
| Professional | TC | $363.08 | $575.44 | $776.25 |