- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $616.60 / $1,659.59
| Facility | 26 | $380.19 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $2,238.72 / $7,943.28
| Professional | | $1,548.82 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $1,445.44
| Professional | 26 | $354.81 | $562.34 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,148.15 / $1,737.80 / $3,890.45
| Professional | TC | $1,148.15 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,621.81 / $2,238.72 / $4,466.84
| Professional | | $1,621.81 | $2,238.72 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $1,000.00
| Professional | 26 | $398.11 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,698.24 / $3,467.37
| Professional | TC | $1,230.27 | $1,698.24 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $616.60 / $2,089.30
| Facility | 26 | $102.33 | $616.60 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,659.59 / $2,754.23 / $5,370.32
| Professional | | $1,659.59 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $380.19 / $602.56 / $1,148.15
| Professional | 26 | $380.19 | $602.56 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,288.25 / $2,238.72 / $4,265.80
| Professional | TC | $1,288.25 | $2,238.72 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $2,398.83 / $4,570.88
| Professional | | $1,513.56 | $2,398.83 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $1,000.00
| Professional | 26 | $338.84 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,230.27 / $1,905.46 / $3,715.35
| Professional | TC | $1,230.27 | $1,905.46 | $3,715.35 |