- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $186.21 / $186.21
| Facility | 26 | $147.91 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $1,778.28
| Professional | | $691.83 | $851.14 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $257.04
| Professional | 26 | $107.15 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $524.81
| Professional | 53 | $426.58 | $426.58 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $707.95 / $1,096.48
| Professional | TC | $588.84 | $707.95 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,071.52
| Professional | | $724.44 | $912.01 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $128.82
| Professional | 26 | $117.49 | $117.49 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Professional | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,202.26 / $1,698.24
| Professional | | $724.44 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $223.87 / $331.13
| Professional | 26 | $114.82 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $602.56 / $954.99 / $1,380.38
| Professional | TC | $602.56 | $954.99 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $794.33
| Facility | 26 | $257.04 | $257.04 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $645.65
| Facility | 53 | $281.84 | $281.84 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,202.26 / $5,370.32
| Professional | | $870.96 | $1,202.26 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $223.87 / $1,047.13
| Professional | 26 | $131.83 | $223.87 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $4,466.84
| Professional | TC | $724.44 | $1,000.00 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,071.52 / $1,548.82
| Professional | | $870.96 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $181.97 / $263.03
| Professional | 26 | $131.83 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $891.25 / $1,348.96
| Professional | TC | $724.44 | $891.25 | $1,348.96 |