- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $186.21
| Facility | 26 | $181.97 | $181.97 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,148.15 / $3,467.37
| Professional | | $707.95 | $1,148.15 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $218.78 / $588.84
| Professional | 26 | $109.65 | $218.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $891.25 / $1,479.11
| Professional | 52 | $275.42 | $891.25 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $549.54 / $549.54
| Professional | 53 | $398.11 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $758.58 / $1,698.24
| Professional | TC | $575.44 | $758.58 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $794.33
| Facility | 26 | $245.47 | $275.42 | $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
- $707.95 / $1,318.26 / $5,495.41
| Professional | | $707.95 | $1,318.26 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $223.87 / $1,096.48
| Professional | 26 | $117.49 | $223.87 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $1,148.15 / $4,570.88
| Professional | TC | $676.08 | $1,148.15 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,348.96 / $1,737.80 / $6,025.60
| Professional | | $1,348.96 | $1,737.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $208.93 / $758.58
| Professional | 26 | $169.82 | $208.93 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $676.08 / $870.96 / $3,019.95
| Professional | 52 | $676.08 | $870.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $338.84 / $436.52 / $1,513.56
| Professional | 53 | $338.84 | $436.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,318.26 / $2,570.40
| Professional | | $724.44 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $426.58
| Professional | 26 | $112.20 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | 53 | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $1,096.48 / $2,137.96
| Professional | TC | $630.96 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $549.54 / $1,318.26
| Professional | | $87.10 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $891.25 / $1,348.96 / $2,187.76
| Professional | | $891.25 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $323.59
| Professional | 26 | $128.82 | $194.98 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $1,096.48 / $1,862.09
| Professional | TC | $741.31 | $1,096.48 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $229.09 / $1,584.89
| Professional | | $199.53 | $229.09 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $275.42 / $794.33
| Facility | 26 | $245.47 | $275.42 | $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
- $707.95 / $1,318.26 / $5,495.41
| Professional | | $707.95 | $1,318.26 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $223.87 / $1,096.48
| Professional | 26 | $117.49 | $223.87 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $1,148.15 / $4,570.88
| Professional | TC | $676.08 | $1,148.15 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,348.96 / $2,398.83
| Professional | | $870.96 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $371.54
| Professional | 26 | $131.83 | $213.80 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $1,122.02 / $2,041.74
| Professional | TC | $741.31 | $1,122.02 | $2,041.74 |