- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $38.90 / $45.71
| Facility | 26 | $37.15 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $288.40 / $588.84
| Professional | | $223.87 | $288.40 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $83.18
| Professional | 26 | $33.88 | $41.69 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $234.42 / $416.87
| Professional | TC | $190.55 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $380.19
| Professional | | $223.87 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $57.54
| Professional | 26 | $36.31 | $56.23 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $446.68
| Professional | | $223.87 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $69.18
| Professional | 26 | $35.48 | $41.69 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $223.87 / $380.19
| Professional | TC | $190.55 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $281.84 / $371.54
| Professional | | $245.47 | $281.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $60.26
| Professional | 26 | $38.02 | $45.71 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $323.59
| Professional | TC | $208.93 | $251.19 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $43.65 / $61.66
| Facility | 26 | $9.33 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $691.83
| Professional | | $239.88 | $338.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $102.33
| Professional | 26 | $37.15 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $588.84
| Professional | TC | $204.17 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $169.82 / $169.82
| Facility | 26 | $87.10 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $1,621.81
| Professional | | $239.88 | $338.84 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $51.29 / $234.42
| Professional | 26 | $36.31 | $51.29 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $288.40 / $1,380.38
| Professional | TC | $204.17 | $288.40 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $467.74
| Professional | | $239.88 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $45.71 / $72.44
| Professional | 26 | $35.48 | $45.71 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $407.38
| Professional | TC | $204.17 | $257.04 | $407.38 |