- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $19.50 / $41.69
| Facility | 26 | $18.20 | $19.50 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $229.09
| Professional | | $72.44 | $107.15 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $28.84 / $67.61
| Professional | 26 | $19.50 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $144.54
| Professional | TC | $52.48 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $117.49
| Professional | | $75.86 | $89.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $29.51 / $58.88
| Professional | 26 | $22.39 | $29.51 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Professional | TC | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $79.43 / $107.15
| Professional | | $21.88 | $79.43 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $131.83 / $186.21
| Professional | | $87.10 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $69.18 / $69.18
| Professional | 26 | $26.92 | $69.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $32.36 / $46.77
| Facility | 26 | $6.92 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $213.80
| Professional | | $83.18 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $61.66
| Professional | 26 | $23.44 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $162.18
| Professional | TC | $58.88 | $81.28 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | 26 | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $891.25 / $891.25
| Professional | | $676.08 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $229.09 / $229.09
| Professional | 26 | $181.97 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $489.78 / $660.69 / $660.69
| Professional | TC | $489.78 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $38.02
| Facility | 26 | $18.20 | $22.91 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $123.03 / $239.88
| Professional | | $75.86 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.88 / $64.57
| Professional | 26 | $20.42 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $173.78
| Professional | TC | $56.23 | $91.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $87.10
| Professional | | $23.44 | $33.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $158.49 / $281.84
| Professional | | $125.89 | $158.49 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $34.67 / $48.98
| Facility | 26 | $7.41 | $34.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $218.78
| Professional | | $83.18 | $112.20 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $54.95
| Professional | 26 | $23.44 | $29.51 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $144.54
| Professional | TC | $58.88 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $194.98
| Professional | | $87.10 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $66.07
| Professional | 26 | $24.55 | $31.62 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $131.83
| Professional | TC | $63.10 | $83.18 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $112.20 / $134.90
| Professional | | $107.15 | $112.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $29.51 / $35.48
| Professional | 26 | $28.18 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $83.18 / $100.00
| Professional | TC | $79.43 | $83.18 | $100.00 |