- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $57.54 / $85.11
| Facility | 26 | $35.48 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $251.19 / $741.31
| Professional | | $109.65 | $251.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $70.79 / $316.23
| Professional | 26 | $30.90 | $70.79 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $56.23 / $134.90 / $338.84
| Professional | 52 | $56.23 | $134.90 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $128.82 / $512.86
| Professional | TC | $72.44 | $128.82 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $181.97 / $562.34
| Professional | | $117.49 | $181.97 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $173.78
| Professional | 26 | $32.36 | $50.12 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $416.87
| Professional | TC | $83.18 | $131.83 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $102.33 / $169.82
| Professional | | $41.69 | $102.33 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $100.00 / $162.18
| Facility | 26 | $87.10 | $100.00 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $354.81 / $489.78
| Professional | | $128.82 | $354.81 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $97.72 / $131.83
| Professional | 26 | $38.02 | $97.72 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $239.88 / $354.81
| Professional | TC | $89.13 | $239.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $245.47 / $331.13
| Professional | | $213.80 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $69.18 / $91.20
| Professional | 26 | $60.26 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $177.83 / $239.88
| Professional | TC | $154.88 | $177.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $147.91 / $245.47
| Facility | 26 | $120.23 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $269.15 / $831.76
| Professional | | $120.23 | $269.15 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $100.00 / $323.59
| Professional | 26 | $36.31 | $100.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Professional | 52 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $158.49 / $575.44
| Professional | TC | $81.28 | $158.49 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $125.89
| Professional | | $32.36 | $33.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $208.93 / $426.58
| Professional | | $154.88 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $120.23
| Professional | 26 | $43.65 | $56.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $144.54 / $302.00
| Professional | TC | $112.20 | $144.54 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $288.40 / $524.81
| Professional | | $151.36 | $288.40 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $208.93 / $208.93
| Facility | 26 | $100.00 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $602.56 / $776.25
| Professional | | $144.54 | $602.56 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $169.82 / $288.40
| Professional | 26 | $39.81 | $169.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $426.58 / $575.44
| Professional | TC | $104.71 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 26 | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | TC | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $758.58
| Professional | | $302.00 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $123.03 / $190.55
| Professional | 26 | $100.00 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $416.87
| Professional | TC | $173.78 | $251.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $302.00 / $912.01
| Professional | | $85.11 | $302.00 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $107.15 / $251.19
| Professional | 26 | $60.26 | $107.15 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $263.03 / $660.69
| Professional | TC | $85.11 | $263.03 | $660.69 |