- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $208.93 / $630.96
| Facility | 26 | $186.21 | $208.93 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,288.25 / $4,570.88
| Professional | | $776.25 | $1,288.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $257.04 / $831.76
| Professional | 26 | $114.82 | $257.04 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $977.24 / $3,630.78
| Professional | 52 | $275.42 | $977.24 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $1,698.24
| Professional | 53 | $398.11 | $549.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $812.83 / $1,698.24
| Professional | TC | $616.60 | $812.83 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $645.65 / $933.25
| Professional | | $501.19 | $645.65 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | 26 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,348.96 / $2,511.89
| Professional | | $851.14 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $426.58
| Professional | 26 | $173.78 | $269.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $1,096.48 / $2,137.96
| Professional | TC | $676.08 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,288.25 / $2,511.89
| Professional | | $851.14 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $263.03 / $467.74
| Professional | 26 | $186.21 | $263.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $1,023.29 / $2,089.30
| Professional | TC | $676.08 | $1,023.29 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $125.89 / $177.83
| Facility | 26 | $26.92 | $125.89 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $36.31 / $181.97 / $213.80
| Facility | 53 | $36.31 | $181.97 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,202.26 / $2,238.72
| Professional | | $812.83 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $213.80 / $363.08
| Professional | 26 | $128.82 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $524.81 / $524.81 / $524.81
| Professional | 53 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $977.24 / $1,905.46
| Professional | TC | $660.69 | $977.24 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,096.48 / $1,479.11
| Professional | | $812.83 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $190.55
| Professional | 26 | $120.23 | $141.25 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $954.99 / $1,288.25
| Professional | TC | $676.08 | $954.99 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,000.00 / $1,905.46
| Professional | | $794.33 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $263.03
| Professional | 26 | $120.23 | $158.49 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $794.33 / $1,000.00 / $1,698.24
| Professional | TC | $794.33 | $1,000.00 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 53 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5,495.41 / $5,888.44 / $5,888.44
| Professional | | $5,495.41 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,096.48
| Professional | 26 | $933.25 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4,570.88 / $5,011.87 / $5,011.87
| Professional | TC | $4,570.88 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $186.21 / $977.24
| Professional | | $32.36 | $186.21 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | 26 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,258.93 / $2,089.30
| Professional | | $812.83 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $208.93 / $331.13
| Professional | 26 | $123.03 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $1,778.28
| Professional | TC | $630.96 | $954.99 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,884.03 / $2,884.03 / $2,884.03
| Professional | | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $426.58
| Professional | 26 | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2,511.89 / $2,511.89 / $2,511.89
| Professional | TC | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $912.01 / $1,202.26 / $1,737.80
| Professional | | $912.01 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $2,089.30
| Professional | | $691.83 | $977.24 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $323.59
| Professional | 26 | $107.15 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $1,778.28
| Professional | TC | $588.84 | $812.83 | $1,778.28 |