- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $120.23 / $239.88
| Facility | 26 | $114.82 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $954.99 / $2,089.30
| Professional | | $707.95 | $954.99 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $446.68
| Professional | 26 | $107.15 | $177.83 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $213.80 / $794.33 / $1,000.00
| Professional | 52 | $213.80 | $794.33 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $1,513.56 / $1,698.24
| Professional | 53 | $398.11 | $1,513.56 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $741.31 / $1,202.26
| Professional | TC | $588.84 | $741.31 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $1,122.02 / $1,548.82
| Professional | | $512.86 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $147.91 / $218.78
| Professional | 26 | $114.82 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $389.05
| Professional | 52 | $186.21 | $295.12 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,047.13 / $1,737.80
| Professional | | $776.25 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $208.93 / $338.84
| Professional | 26 | $144.54 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $870.96 / $1,445.44
| Professional | TC | $660.69 | $870.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,148.15 / $1,995.26
| Professional | | $794.33 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $363.08
| Professional | 26 | $123.03 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,445.44
| Professional | 53 | $1,288.25 | $1,288.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $1,698.24
| Professional | TC | $630.96 | $954.99 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,047.13 / $2,290.87
| Professional | | $812.83 | $1,047.13 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $154.88 / $501.19
| Professional | 26 | $120.23 | $154.88 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $645.65
| Professional | 52 | $389.05 | $389.05 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $389.05 / $645.65 / $851.14
| Professional | 53 | $389.05 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $912.01 / $1,819.70
| Professional | TC | $691.83 | $912.01 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,202.26 / $1,995.26 / $2,290.87
| Professional | | $1,202.26 | $1,995.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,096.48 / $1,905.46
| Professional | | $794.33 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $323.59
| Professional | 26 | $120.23 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $891.25 / $1,621.81
| Professional | TC | $645.65 | $891.25 | $1,621.81 |