- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $117.49 / $245.47
| Facility | 26 | $63.10 | $117.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $1,174.90
| Professional | | $186.21 | $302.00 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $234.42
| Professional | 26 | $61.66 | $102.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $190.55 / $467.74
| Professional | TC | $120.23 | $190.55 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $269.15
| Professional | | $144.54 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $123.03
| Professional | 26 | $58.88 | $93.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $81.28 / $102.33
| Professional | 26 | $75.86 | $81.28 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $239.88 / $562.34
| Professional | | $181.97 | $239.88 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $83.18 / $158.49
| Professional | 26 | $64.57 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $158.49 / $467.74
| Professional | TC | $117.49 | $158.49 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $512.86
| Professional | | $186.21 | $309.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $134.90
| Professional | 26 | $50.12 | $81.28 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $213.80 / $380.19
| Professional | TC | $123.03 | $213.80 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $309.03
| Professional | | $190.55 | $257.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $102.33
| Professional | 26 | $64.57 | $87.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $165.96 / $208.93
| Professional | TC | $125.89 | $165.96 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $251.19 / $478.63
| Professional | | $190.55 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $138.04
| Professional | 26 | $56.23 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $173.78 / $346.74
| Professional | TC | $120.23 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $229.09 / $245.47
| Professional | | $213.80 | $229.09 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $79.43 / $112.20
| Professional | 26 | $69.18 | $79.43 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $316.23
| Professional | TC | $181.97 | $218.78 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $81.28 / $102.33
| Professional | 26 | $75.86 | $81.28 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $154.88
| Facility | 26 | $63.10 | $91.20 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $524.81
| Professional | | $186.21 | $281.84 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $83.18 / $144.54
| Professional | 26 | $61.66 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $194.98 / $380.19
| Professional | TC | $123.03 | $194.98 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $323.59 / $524.81
| Professional | | $109.65 | $323.59 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $75.86
| Facility | 26 | $64.57 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $186.21 / $371.54
| Professional | | $181.97 | $186.21 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $75.86
| Professional | 26 | $63.10 | $64.57 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $120.23 / $295.12
| Professional | TC | $117.49 | $120.23 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $257.04 / $426.58
| Professional | | $165.96 | $257.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $138.04
| Professional | 26 | $56.23 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $173.78 / $338.84
| Professional | TC | $107.15 | $173.78 | $338.84 |