- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $229.09 / $398.11
| Facility | 26 | $54.95 | $229.09 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $234.42 / $707.95
| Professional | | $169.82 | $234.42 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $186.21
| Professional | 26 | $44.67 | $63.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $512.86
| Professional | TC | $120.23 | $173.78 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $2,344.23 / $3,162.28
| Professional | | $309.03 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $95.50
| Professional | 26 | $79.43 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | TC | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $575.44 / $933.25
| Professional | | $199.53 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $234.42
| Professional | 26 | $52.48 | $70.79 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $478.63 / $724.44
| Professional | TC | $144.54 | $478.63 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $478.63 / $524.81
| Professional | | $245.47 | $478.63 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $134.90
| Professional | 26 | $63.10 | $123.03 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $389.05
| Professional | TC | $181.97 | $354.81 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $446.68 / $794.33
| Professional | | $229.09 | $446.68 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $87.10 / $204.17
| Professional | 26 | $46.77 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $389.05 / $588.84
| Professional | TC | $169.82 | $389.05 | $588.84 |