- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $162.18
| Facility | 26 | $100.00 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $2,238.72
| Professional | | $691.83 | $977.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $524.81
| Professional | 26 | $107.15 | $181.97 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $154.88 / $794.33 / $1,000.00
| Professional | 52 | $154.88 | $794.33 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $275.42 / $426.58 / $1,698.24
| Professional | 53 | $275.42 | $426.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,380.38
| Professional | TC | $562.34 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $645.65 / $954.99
| Professional | | $562.34 | $645.65 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $213.80
| Professional | 26 | $93.33 | $158.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Professional | 52 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $691.83 / $776.25
| Professional | | $549.54 | $691.83 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $125.89 / $213.80
| Facility | 26 | $26.92 | $125.89 | $213.80 |
- 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
- $676.08 / $1,071.52 / $1,995.26
| Professional | | $676.08 | $1,071.52 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $346.74
| Professional | 26 | $107.15 | $199.53 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $891.25 / $1,659.59
| Professional | TC | $575.44 | $891.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Facility | 26 | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $676.08 / $1,047.13
| Professional | | $501.19 | $676.08 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $204.17
| Professional | 26 | $81.28 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $524.81 / $891.25
| Professional | TC | $389.05 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $426.58 / $1,071.52
| Professional | | $32.36 | $426.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $954.99 / $1,698.24
| Professional | | $676.08 | $954.99 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $173.78 / $302.00
| Professional | 26 | $109.65 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $776.25 / $1,412.54
| Professional | TC | $549.54 | $776.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $537.03 / $537.03 / $812.83
| Professional | | $537.03 | $537.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $120.23
| Professional | 26 | $85.11 | $85.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $691.83
| Professional | TC | $446.68 | $446.68 | $691.83 |