- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $208.93 / $223.87 / $223.87
| Facility | 26 | $208.93 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 53 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $933.25 / $2,089.30
| Professional | | $707.95 | $933.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $457.09
| Professional | 26 | $107.15 | $177.83 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $154.88 / $794.33 / $1,071.52
| Professional | 52 | $154.88 | $794.33 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $676.08
| Professional | 53 | $398.11 | $398.11 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $741.31 / $1,548.82
| Professional | TC | $575.44 | $741.31 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $645.65 / $645.65
| Professional | | $616.60 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,230.27 / $2,570.40
| Professional | | $758.58 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 26 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $691.83 / $1,122.02 / $1,995.26
| Professional | | $691.83 | $1,122.02 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $204.17 / $331.13
| Professional | 26 | $102.33 | $204.17 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $575.44 / $933.25 / $1,659.59
| Professional | TC | $575.44 | $933.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,258.93 / $1,412.54
| Professional | | $831.76 | $1,258.93 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $199.53
| Professional | 26 | $117.49 | $177.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $1,071.52 / $1,230.27
| Professional | TC | $707.95 | $1,071.52 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $1,023.29 / $1,949.84
| Professional | | $724.44 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $354.81
| Professional | 26 | $100.00 | $144.54 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $891.25 / $1,621.81
| Professional | TC | $630.96 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $977.24 / $1,698.24
| Professional | | $660.69 | $977.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $151.36 / $275.42
| Professional | 26 | $95.50 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $562.34 / $812.83 / $1,445.44
| Professional | TC | $562.34 | $812.83 | $1,445.44 |