- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $45.71 / $54.95
| Facility | 26 | $38.90 | $45.71 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $112.20 / $245.47
| Professional | | $75.86 | $112.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $85.11
| Professional | 26 | $22.91 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $81.28 / $144.54
| Professional | TC | $56.23 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $512.86
| Professional | | $95.50 | $147.91 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $141.25
| Professional | 26 | $25.70 | $39.81 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $363.08
| Professional | TC | $69.18 | $109.65 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $128.82
| Facility | 26 | $69.18 | $81.28 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $269.15 / $407.38
| Professional | | $97.72 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $69.18 / $107.15
| Professional | 26 | $28.18 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $199.53 / $302.00
| Professional | TC | $72.44 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $218.78 / $295.12
| Professional | | $181.97 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $77.62
| Professional | 26 | $47.86 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $218.78
| Professional | TC | $134.90 | $158.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Facility | 26 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $645.65
| Professional | | $97.72 | $169.82 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $52.48 / $165.96
| Professional | 26 | $28.18 | $52.48 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $120.23 / $478.63
| Professional | TC | $67.61 | $120.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $104.71
| Professional | | $32.36 | $33.11 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $323.59
| Professional | | $123.03 | $190.55 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $60.26 / $97.72
| Professional | 26 | $33.11 | $60.26 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $229.09
| Professional | TC | $95.50 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $229.09 / $338.84
| Professional | | $120.23 | $229.09 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $165.96 / $165.96
| Facility | 26 | $60.26 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $457.09 / $645.65
| Professional | | $102.33 | $457.09 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $138.04 / $165.96
| Professional | 26 | $31.62 | $138.04 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $323.59 / $478.63
| Professional | TC | $72.44 | $323.59 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | 26 | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | TC | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $616.60 / $758.58
| Professional | | $549.54 | $616.60 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $158.49 / $223.87
| Professional | 26 | $107.15 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $436.52 / $524.81
| Professional | TC | $138.04 | $436.52 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $338.84
| Professional | | $97.72 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $169.82
| Professional | 26 | $46.77 | $95.50 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $234.42
| Professional | TC | $67.61 | $102.33 | $234.42 |