- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $54.95
| Facility | 26 | $46.77 | $46.77 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $281.84 / $524.81
| Professional | | $208.93 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $109.65
| Professional | 26 | $41.69 | $54.95 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $436.52
| Professional | TC | $162.18 | $234.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $204.17 / $208.93
| Professional | | $190.55 | $204.17 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $69.18 / $70.79
| Professional | 26 | $34.67 | $69.18 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $436.52
| Professional | | $204.17 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $93.33
| Professional | 26 | $47.86 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $363.08
| Professional | TC | $154.88 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $316.23 / $478.63
| Professional | | $263.03 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $72.44
| Professional | 26 | $46.77 | $54.95 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $263.03 / $389.05
| Professional | TC | $218.78 | $263.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $51.29 / $72.44
| Facility | 26 | $10.96 | $51.29 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $724.44
| Professional | | $239.88 | $371.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $131.83
| Professional | 26 | $44.67 | $64.57 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $616.60
| Professional | TC | $208.93 | $323.59 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $204.17 / $204.17
| Facility | 26 | $104.71 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $1,905.46
| Professional | | $251.19 | $380.19 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $588.84
| Professional | 26 | $44.67 | $67.61 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $323.59 / $1,621.81
| Professional | TC | $208.93 | $323.59 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $512.86
| Professional | | $251.19 | $331.13 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $102.33
| Professional | 26 | $43.65 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $275.42 / $416.87
| Professional | TC | $208.93 | $275.42 | $416.87 |