- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $95.50
| Facility | 26 | $43.65 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $257.04 / $724.44
| Professional | | $131.83 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $60.26 / $190.55
| Professional | 26 | $38.02 | $60.26 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $316.23
| Professional | TC | $89.13 | $151.36 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $100.00 / $120.23
| Professional | | $85.11 | $100.00 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $213.80
| Professional | 26 | $22.91 | $36.31 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $457.09
| Professional | | $128.82 | $162.18 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $46.77 / $97.72
| Professional | 26 | $37.15 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $295.12
| Professional | TC | $91.20 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $134.90 / $194.98
| Professional | | $58.88 | $134.90 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $46.77 / $66.07
| Facility | 26 | $10.00 | $46.77 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $870.96
| Professional | | $117.49 | $263.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $66.07 / $173.78
| Professional | 26 | $33.11 | $66.07 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $190.55 / $724.44
| Professional | TC | $77.62 | $190.55 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $275.42
| Professional | | $134.90 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $177.83
| Professional | 26 | $39.81 | $56.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $194.98
| Professional | TC | $97.72 | $128.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $213.80 / $323.59
| Professional | | $120.23 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $58.88 / $102.33
| Professional | 26 | $37.15 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $154.88 / $223.87
| Professional | TC | $81.28 | $154.88 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $37.15
| Professional | 26 | $33.88 | $35.48 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $154.88 / $316.23
| Professional | | $138.04 | $154.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $48.98 / $85.11
| Professional | 26 | $44.67 | $48.98 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | TC | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $190.55 / $346.74
| Professional | | $158.49 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $58.88 / $107.15
| Professional | 26 | $48.98 | $58.88 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $131.83 / $239.88
| Professional | TC | $112.20 | $131.83 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $194.98 / $851.14
| Professional | | $120.23 | $194.98 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $338.84
| Professional | 26 | $38.02 | $57.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $138.04 / $630.96
| Professional | TC | $87.10 | $138.04 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $46.77 / $181.97
| Facility | 26 | $33.11 | $46.77 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $199.53 / $354.81
| Professional | | $120.23 | $199.53 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $109.65
| Professional | 26 | $35.48 | $58.88 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $245.47
| Professional | TC | $74.13 | $147.91 | $245.47 |