- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $165.96 / $165.96
| Facility | 26 | $128.82 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,000.00 / $2,884.03
| Professional | | $724.44 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $204.17 / $831.76
| Professional | 26 | $109.65 | $204.17 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $891.25
| Professional | 52 | $213.80 | $363.08 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $1,698.24
| Professional | 53 | $275.42 | $398.11 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $758.58 / $1,412.54
| Professional | TC | $588.84 | $758.58 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $616.60
| Professional | | $562.34 | $562.34 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $120.23
| Professional | 26 | $93.33 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $1,122.02
| Professional | | $870.96 | $1,047.13 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $147.91 / $173.78 / $173.78
| Professional | 26 | $147.91 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,258.93
| Professional | TC | $933.25 | $933.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,000.00 / $2,137.96
| Professional | | $691.83 | $1,000.00 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $331.13
| Professional | 26 | $120.23 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $812.83 / $1,819.70
| Professional | TC | $575.44 | $812.83 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $128.82 / $478.63 / $562.34
| Facility | 26 | $128.82 | $478.63 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,000.00 / $2,089.30
| Professional | | $758.58 | $1,000.00 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $190.55 / $489.78
| Professional | 26 | $117.49 | $190.55 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $891.25
| Professional | 52 | $302.00 | $302.00 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $275.42 / $398.11 / $1,698.24
| Professional | 53 | $275.42 | $398.11 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $1,479.11
| Professional | TC | $645.65 | $794.33 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $912.01 / $1,513.56
| Professional | | $741.31 | $912.01 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $173.78 / $316.23
| Professional | 26 | $123.03 | $173.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $776.25 / $1,230.27
| Professional | TC | $575.44 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $977.24 / $1,513.56
| Professional | | $794.33 | $977.24 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $257.04
| Professional | 26 | $123.03 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $794.33 / $1,258.93
| Professional | TC | $645.65 | $794.33 | $1,258.93 |