- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $128.82 / $218.78
| Facility | 26 | $117.49 | $128.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $724.44 / $1,174.90
| Professional | | $549.54 | $724.44 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $181.97 / $512.86
| Professional | 26 | $112.20 | $181.97 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $128.82 / $257.04 / $588.84
| Professional | 52 | $128.82 | $257.04 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $588.84 / $1,000.00
| Professional | TC | $446.68 | $588.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $104.71 / $104.71
| Facility | 26 | $87.10 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,584.89 / $2,238.72
| Professional | | $912.01 | $1,584.89 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $295.12 / $416.87
| Professional | 26 | $169.82 | $295.12 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $758.58 / $1,380.38 / $1,862.09
| Professional | TC | $758.58 | $1,380.38 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $309.03 / $436.52 / $1,023.29
| Facility | 26 | $309.03 | $436.52 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,380.38 / $1,659.59
| Professional | | $1,318.26 | $1,380.38 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $251.19 / $302.00
| Professional | 26 | $234.42 | $251.19 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,071.52 / $1,148.15 / $1,348.96
| Professional | TC | $1,071.52 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $331.13 / $416.87 / $812.83
| Facility | 26 | $331.13 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $251.19
| Professional | 26 | $234.42 | $234.42 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,071.52 / $1,071.52 / $1,071.52
| Professional | TC | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,288.25 / $6,165.95
| Professional | | $645.65 | $1,288.25 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $2,570.40
| Professional | 26 | $128.82 | $269.15 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $1,000.00 / $7,079.46
| Professional | TC | $512.86 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $645.65 / $1,258.93 / $2,187.76
| Professional | | $645.65 | $1,258.93 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $239.88 / $416.87
| Professional | 26 | $125.89 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $1,023.29 / $1,778.28
| Professional | TC | $524.81 | $1,023.29 | $1,778.28 |