- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.18
| Facility | 26 | $22.91 | $22.91 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $275.42 / $1,412.54
| Professional | | $218.78 | $275.42 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $134.90
| Professional | 26 | $19.95 | $32.36 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $245.47 / $602.56
| Professional | TC | $181.97 | $245.47 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | 26 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $223.87 / $346.74
| Professional | | $213.80 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $35.48
| Professional | 26 | $21.88 | $21.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $199.53 / $316.23
| Professional | TC | $190.55 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $416.87
| Professional | | $204.17 | $363.08 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $34.67 / $44.67
| Professional | 26 | $19.50 | $34.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $323.59 / $371.54
| Professional | TC | $186.21 | $323.59 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $281.84 / $354.81
| Professional | | $2.24 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $30.20 / $38.02
| Professional | 26 | $0.27 | $30.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $251.19 / $331.13
| Professional | TC | $2.00 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $316.23
| Professional | | $2.24 | $2.24 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.27 / $0.27 / $33.88
| Professional | 26 | $0.27 | $0.27 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $281.84 / $346.74
| Professional | TC | $2.00 | $281.84 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $208.93 / $208.93
| Professional | | $199.53 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | 26 | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $186.21 / $186.21
| Professional | TC | $177.83 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $213.80 / $446.68
| Professional | | $30.90 | $213.80 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $46.77
| Professional | 26 | $19.95 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $416.87
| Professional | TC | $181.97 | $281.84 | $416.87 |