- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | 26 | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $245.47 / $338.84
| Professional | | $194.98 | $245.47 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $53.70 / $102.33
| Professional | 26 | $22.91 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $218.78 / $316.23
| Professional | TC | $177.83 | $218.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $512.86 / $645.65
| Professional | | $467.74 | $512.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $53.70 / $67.61
| Professional | 26 | $48.98 | $53.70 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $467.74 / $575.44
| Professional | TC | $426.58 | $467.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $549.54
| Professional | | $204.17 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $32.36 / $69.18
| Professional | 26 | $21.38 | $32.36 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $295.12 / $645.65
| Professional | TC | $190.55 | $295.12 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | 26 | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $489.78
| Professional | TC | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $416.87 / $426.58
| Professional | | $302.00 | $416.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $44.67
| Professional | 26 | $30.20 | $40.74 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $371.54 / $380.19
| Professional | TC | $269.15 | $371.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $602.56
| Professional | | $263.03 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $63.10
| Professional | 26 | $26.92 | $39.81 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $537.03
| Professional | TC | $234.42 | $363.08 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $426.58 / $426.58
| Professional | | $363.08 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $46.77 / $46.77
| Professional | 26 | $39.81 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $380.19 / $380.19
| Professional | TC | $323.59 | $380.19 | $380.19 |