- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $263.03
| Facility | 26 | $109.65 | $154.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $2,630.27
| Professional | | $691.83 | $977.24 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $186.21 / $537.03
| Professional | 26 | $104.71 | $186.21 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $275.42 / $891.25 / $1,000.00
| Professional | 52 | $275.42 | $891.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $398.11
| Professional | 53 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $741.31 / $1,513.56
| Professional | TC | $575.44 | $741.31 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $1,122.02 / $1,258.93
| Professional | | $616.60 | $1,122.02 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Professional | 26 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $977.24 / $1,479.11
| Professional | | $812.83 | $977.24 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $204.17 / $281.84
| Professional | 26 | $134.90 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $776.25 / $1,174.90
| Professional | TC | $645.65 | $776.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $977.24 / $1,230.27
| Professional | | $776.25 | $977.24 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $151.36 / $234.42
| Professional | 26 | $120.23 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $660.69 / $794.33 / $1,023.29
| Professional | TC | $660.69 | $794.33 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $125.89 / $177.83
| Facility | 26 | $26.92 | $125.89 | $177.83 |
- 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
- $724.44 / $1,148.15 / $2,137.96
| Professional | | $724.44 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $204.17 / $363.08
| Professional | 26 | $114.82 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $933.25 / $1,778.28
| Professional | TC | $616.60 | $933.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $257.04 / $794.33 / $794.33
| Facility | 26 | $257.04 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $281.84 / $645.65 / $645.65
| Facility | 53 | $281.84 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,230.27 / $5,370.32
| Professional | | $851.14 | $1,230.27 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $218.78 / $1,047.13
| Professional | 26 | $131.83 | $218.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $1,023.29 / $4,466.84
| Professional | TC | $707.95 | $1,023.29 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,000.00 / $1,584.89
| Professional | | $794.33 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $275.42
| Professional | 26 | $120.23 | $165.96 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $645.65 / $812.83 / $1,288.25
| Professional | TC | $645.65 | $812.83 | $1,288.25 |