- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $47.86 / $125.89
| Facility | 26 | $40.74 | $47.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $208.93 / $588.84
| Professional | | $112.20 | $208.93 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $47.86 / $151.36
| Professional | 26 | $33.88 | $47.86 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $39.81 / $144.54 / $724.44
| Professional | 52 | $39.81 | $144.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $112.20 / $346.74
| Professional | TC | $81.28 | $112.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $181.97 / $302.00
| Professional | | $107.15 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $54.95 / $70.79
| Professional | 26 | $26.92 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $53.70 / $66.07 / $70.79
| Professional | 52 | $53.70 | $66.07 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $177.83 / $213.80
| Professional | TC | $89.13 | $177.83 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 26 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $371.54
| Professional | | $177.83 | $269.15 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $107.15
| Professional | 26 | $50.12 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $275.42
| Professional | TC | $131.83 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $229.09 / $389.05
| Professional | | $123.03 | $229.09 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $61.66 / $107.15
| Professional | 26 | $32.36 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $165.96 / $288.40
| Professional | TC | $87.10 | $165.96 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $69.18 / $109.65
| Facility | 26 | $41.69 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $245.47 / $346.74
| Professional | | $138.04 | $245.47 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $66.07 / $91.20
| Professional | 26 | $35.48 | $66.07 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $177.83 / $251.19
| Professional | TC | $100.00 | $177.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $186.21
| Professional | | $51.29 | $77.62 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | 26 | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $263.03 / $371.54
| Professional | | $173.78 | $263.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $104.71
| Professional | 26 | $48.98 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $194.98 / $269.15
| Professional | TC | $125.89 | $194.98 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | 26 | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $363.08
| Professional | | $177.83 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $102.33
| Professional | 26 | $48.98 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $263.03
| Professional | TC | $128.82 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $363.08
| Professional | | $125.89 | $173.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $100.00
| Professional | 26 | $38.90 | $48.98 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $120.23 / $257.04
| Professional | TC | $91.20 | $120.23 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $281.84
| Professional | | $151.36 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $40.74 / $72.44
| Professional | 26 | $38.02 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $112.20 / $213.80
| Professional | TC | $109.65 | $112.20 | $213.80 |