- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $309.03
| Facility | 26 | $295.12 | $295.12 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,148.15 / $1,995.26
| Professional | | $977.24 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $389.05 / $776.25
| Professional | 26 | $257.04 | $389.05 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $851.14 / $1,445.44
| Professional | TC | $676.08 | $851.14 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $234.42
| Facility | 26 | $194.98 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $2,137.96 / $3,548.13
| Professional | | $1,445.44 | $2,137.96 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $416.87 / $616.60 / $1,023.29
| Professional | 26 | $416.87 | $616.60 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,023.29 / $1,698.24 / $2,630.27
| Professional | TC | $1,023.29 | $1,698.24 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $707.95 / $1,000.00 / $2,344.23
| Facility | 26 | $707.95 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,162.28 / $4,365.16
| Professional | | $2,089.30 | $3,162.28 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $549.54 / $831.76 / $1,148.15
| Professional | 26 | $549.54 | $831.76 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,513.56 / $2,290.87 / $3,090.30
| Professional | TC | $1,513.56 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $758.58 / $954.99 / $1,862.09
| Facility | 26 | $758.58 | $954.99 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,905.46 / $2,691.53 / $3,981.07
| Professional | | $1,905.46 | $2,691.53 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $512.86 / $707.95 / $1,071.52
| Professional | 26 | $512.86 | $707.95 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,412.54 / $1,949.84 / $2,951.21
| Professional | TC | $1,412.54 | $1,949.84 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,041.74 / $3,981.07
| Professional | | $1,288.25 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $575.44 / $1,071.52
| Professional | 26 | $363.08 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $1,445.44 / $2,884.03
| Professional | TC | $933.25 | $1,445.44 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $2,238.72 / $3,801.89
| Professional | | $1,318.26 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $371.54 / $588.84 / $1,047.13
| Professional | 26 | $371.54 | $588.84 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $1,621.81 / $2,818.38
| Professional | TC | $933.25 | $1,621.81 | $2,818.38 |