- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $691.83 / $1,348.96
| Professional | | $602.56 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $407.38
| Professional | 26 | $114.82 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $257.04 / $269.15 / $275.42
| Professional | 52 | $257.04 | $269.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $562.34 / $954.99
| Professional | TC | $467.74 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $691.83 / $1,288.25
| Professional | | $478.63 | $691.83 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $239.88
| Professional | 26 | $87.10 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $575.44 / $1,023.29
| Professional | TC | $398.11 | $575.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $954.99 / $1,445.44
| Professional | | $724.44 | $954.99 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $194.98 / $281.84
| Professional | 26 | $134.90 | $194.98 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $1,174.90
| Professional | TC | $588.84 | $776.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $977.24 / $1,905.46
| Professional | | $707.95 | $977.24 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $338.84
| Professional | 26 | $125.89 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $588.84 / $812.83 / $1,584.89
| Professional | TC | $588.84 | $812.83 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $154.88
| Facility | 26 | $125.89 | $125.89 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $758.58 / $1,258.93
| Professional | | $602.56 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $229.09
| Professional | 26 | $117.49 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $1,071.52
| Professional | TC | $489.78 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $954.99 / $1,479.11
| Professional | | $707.95 | $954.99 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $181.97 / $263.03
| Professional | 26 | $125.89 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $794.33 / $1,230.27
| Professional | TC | $549.54 | $794.33 | $1,230.27 |