- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $25.12
| Facility | 26 | $23.99 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $371.54
| Professional | | $144.54 | $177.83 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $64.57
| Professional | 26 | $21.88 | $25.12 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $302.00
| Professional | TC | $123.03 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $346.74 / $436.52
| Professional | | $288.40 | $346.74 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $60.26
| Professional | 26 | $39.81 | $47.86 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $295.12 / $371.54
| Professional | TC | $245.47 | $295.12 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $309.03 / $1,445.44
| Professional | | $151.36 | $309.03 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $43.65 / $295.12
| Professional | 26 | $24.55 | $43.65 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $269.15 / $1,288.25
| Professional | TC | $147.91 | $269.15 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $371.54
| Professional | | $309.03 | $309.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $54.95
| Professional | 26 | $47.86 | $47.86 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $316.23
| Professional | TC | $263.03 | $263.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $309.03
| Professional | | $190.55 | $288.40 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $47.86
| Professional | 26 | $29.51 | $39.81 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $245.47 / $275.42
| Professional | TC | $162.18 | $245.47 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $288.40 / $398.11
| Professional | | $190.55 | $288.40 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $52.48
| Professional | 26 | $26.30 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $251.19 / $354.81
| Professional | TC | $162.18 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $363.08
| Professional | | $295.12 | $346.74 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $51.29 / $52.48
| Professional | 26 | $42.66 | $51.29 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $295.12 / $309.03
| Professional | TC | $251.19 | $295.12 | $309.03 |