- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $251.19 / $251.19
| Facility | 26 | $245.47 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $1,071.52 / $2,398.83
| Professional | | $741.31 | $1,071.52 | $2,398.83 |
- 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 / $398.11
| Professional | 53 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $616.60 / $776.25 / $1,348.96
| Professional | TC | $616.60 | $776.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $741.31 / $1,380.38
| Professional | | $562.34 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $363.08
| Professional | 26 | $120.23 | $141.25 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $954.99 / $1,778.28
| Professional | | $630.96 | $954.99 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $141.25 / $223.87 / $346.74
| Professional | 26 | $141.25 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $1,584.89
| Professional | TC | $691.83 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | 26 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $776.25 / $1,023.29 / $1,659.59
| Professional | | $776.25 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $316.23
| Professional | 26 | $123.03 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $630.96 / $851.14 / $1,380.38
| Professional | TC | $630.96 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $794.33 / $794.33 / $794.33
| Facility | 26 | $794.33 | $794.33 | $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
- $5,495.41 / $5,888.44 / $5,888.44
| Professional | | $5,495.41 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $1,096.48
| Professional | 26 | $933.25 | $933.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4,570.88 / $5,011.87 / $5,011.87
| Professional | TC | $4,570.88 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,023.29 / $1,659.59
| Professional | | $794.33 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $302.00
| Professional | 26 | $123.03 | $194.98 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $676.08 / $812.83 / $1,380.38
| Professional | TC | $676.08 | $812.83 | $1,380.38 |