- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $56.23
| Facility | 26 | $46.77 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $616.60
| Professional | | $107.15 | $199.53 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $75.86 / $218.78
| Professional | 26 | $39.81 | $75.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $177.83
| Professional | TC | $58.88 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $144.54 / $208.93
| Professional | | $89.13 | $144.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $74.13 / $144.54
| Professional | 26 | $37.15 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $194.98
| Professional | | $107.15 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $75.86
| Professional | 26 | $42.66 | $43.65 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $69.18 / $117.49
| Professional | TC | $66.07 | $69.18 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $154.88 / $229.09
| Professional | | $109.65 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $60.26 / $91.20
| Professional | 26 | $39.81 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $138.04
| Professional | TC | $58.88 | $93.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $134.90 / $194.98
| Professional | | $0.72 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.23 / $52.48 / $77.62
| Professional | 26 | $0.23 | $52.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.50 / $85.11 / $120.23
| Professional | TC | $0.50 | $85.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.72 / $0.72 / $173.78
| Professional | | $0.72 | $0.72 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $69.18
| Professional | 26 | $0.23 | $0.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.50 / $89.13 / $104.71
| Professional | TC | $0.50 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $117.49 / $162.18
| Professional | | $112.20 | $117.49 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $45.71 / $66.07
| Professional | 26 | $44.67 | $45.71 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $70.79 / $95.50
| Professional | TC | $67.61 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $208.93
| Professional | | $79.43 | $125.89 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $51.29 / $83.18
| Professional | 26 | $34.67 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $74.13 / $128.82
| Professional | TC | $63.10 | $74.13 | $128.82 |