- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $87.10 / $190.55
| Facility | 26 | $61.66 | $87.10 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $741.31
| Professional | | $218.78 | $309.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $169.82
| Professional | 26 | $52.48 | $75.86 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $478.63
| Professional | TC | $162.18 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $204.17
| Professional | | $165.96 | $165.96 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $741.31
| Professional | | $208.93 | $263.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $125.89
| Professional | 26 | $50.12 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $537.03
| Professional | TC | $158.49 | $199.53 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $245.47 / $331.13
| Professional | | $83.18 | $245.47 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $66.07 / $93.33
| Facility | 26 | $14.13 | $66.07 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $436.52 / $1,513.56
| Professional | | $223.87 | $436.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $85.11 / $234.42
| Professional | 26 | $44.67 | $85.11 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $363.08 / $1,148.15
| Professional | TC | $173.78 | $363.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $323.59 / $512.86
| Professional | | $245.47 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $239.88
| Professional | 26 | $56.23 | $79.43 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $257.04 / $389.05
| Professional | TC | $190.55 | $257.04 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $338.84 / $616.60
| Professional | | $223.87 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $144.54
| Professional | 26 | $46.77 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $269.15 / $467.74
| Professional | TC | $162.18 | $269.15 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $316.23
| Professional | | $269.15 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $69.18 / $144.54
| Professional | 26 | $63.10 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $371.54 / $676.08
| Professional | | $316.23 | $371.54 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $83.18 / $151.36
| Professional | 26 | $69.18 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $288.40 / $524.81
| Professional | TC | $245.47 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $1,479.11
| Professional | | $229.09 | $354.81 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $363.08
| Professional | 26 | $51.29 | $77.62 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $281.84 / $1,202.26
| Professional | TC | $186.21 | $281.84 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $194.98
| Facility | 26 | $46.77 | $67.61 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $645.65
| Professional | | $223.87 | $316.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $83.18 / $154.88
| Professional | 26 | $46.77 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $501.19
| Professional | TC | $154.88 | $263.03 | $501.19 |