- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $194.98
| Facility | 26 | $27.54 | $44.67 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $194.98 / $549.54
| Professional | | $107.15 | $194.98 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $109.65
| Professional | 26 | $32.36 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $25.70 / $61.66 / $363.08
| Professional | 52 | $25.70 | $61.66 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $107.15 / $245.47
| Professional | TC | $77.62 | $107.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $181.97
| Professional | | $81.28 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $41.69 / $53.70
| Professional | 26 | $19.95 | $41.69 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | 52 | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $134.90 / $134.90
| Professional | TC | $74.13 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $112.20 / $323.59
| Professional | | $91.20 | $112.20 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $72.44
| Professional | 26 | $23.99 | $30.20 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $204.17
| Professional | TC | $66.07 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $131.83 / $186.21
| Professional | | $52.48 | $131.83 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $41.69 / $58.88
| Facility | 26 | $8.91 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $190.55 / $467.74
| Professional | | $107.15 | $190.55 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $52.48 / $125.89
| Professional | 26 | $27.54 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $141.25 / $346.74
| Professional | TC | $77.62 | $141.25 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $169.82 / $275.42
| Professional | | $131.83 | $169.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $52.48 / $112.20
| Professional | 26 | $37.15 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $131.83 / $199.53
| Professional | TC | $97.72 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $165.96 / $302.00
| Professional | | $107.15 | $165.96 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $85.11
| Professional | 26 | $33.11 | $47.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $120.23 / $213.80
| Professional | TC | $69.18 | $120.23 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $54.95
| Professional | 26 | $32.36 | $40.74 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $162.18 / $251.19
| Professional | | $131.83 | $162.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $45.71 / $70.79
| Professional | 26 | $36.31 | $45.71 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $123.03
| Professional | 52 | $66.07 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $114.82 / $125.89
| Professional | TC | $93.33 | $114.82 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $186.21 / $338.84
| Professional | | $158.49 | $186.21 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $95.50
| Professional | 26 | $43.65 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $239.88
| Professional | TC | $114.82 | $134.90 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $169.82 / $501.19
| Professional | | $114.82 | $169.82 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $47.86 / $131.83
| Professional | 26 | $31.62 | $47.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $363.08
| Professional | TC | $85.11 | $125.89 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $51.29
| Facility | 26 | $28.18 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $158.49 / $316.23
| Professional | | $104.71 | $158.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $47.86 / $91.20
| Professional | 26 | $29.51 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $114.82 / $229.09
| Professional | TC | $70.79 | $114.82 | $229.09 |