- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $154.88
| Facility | 26 | $46.77 | $95.50 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $72.44 / $234.42
| Professional | | $54.95 | $72.44 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $57.54 / $229.09
| Professional | 26 | $38.02 | $57.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $44.67
| Professional | TC | $15.14 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $39.81 / $40.74
| Professional | 26 | $37.15 | $39.81 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Professional | TC | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 26 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $204.17
| Professional | | $87.10 | $134.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $144.54
| Professional | 26 | $61.66 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $60.26
| Professional | TC | $25.70 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $125.89 / $199.53
| Professional | | $77.62 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $87.10 / $138.04
| Professional | 26 | $53.70 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $63.10
| Professional | TC | $23.44 | $39.81 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $104.71 / $588.84
| Facility | 26 | $58.88 | $104.71 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $181.97
| Professional | | $83.18 | $141.25 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $97.72 / $123.03
| Professional | 26 | $58.88 | $97.72 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $57.54
| Professional | TC | $25.12 | $42.66 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $45.71 / $112.20
| Professional | | $20.42 | $45.71 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $63.10
| Facility | 26 | $60.26 | $60.26 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $186.21
| Professional | | $89.13 | $138.04 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $131.83
| Professional | 26 | $63.10 | $97.72 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $54.95
| Professional | TC | $26.30 | $40.74 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Facility | 26 | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $134.90 / $204.17
| Professional | | $87.10 | $134.90 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $144.54
| Professional | 26 | $64.57 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $39.81 / $58.88
| Professional | TC | $27.54 | $39.81 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $165.96
| Professional | | $58.88 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $58.88 / $117.49
| Professional | 26 | $40.74 | $58.88 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $23.99 / $47.86
| Professional | TC | $17.38 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $141.25
| Professional | | $74.13 | $91.20 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $95.50
| Professional | 26 | $50.12 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $44.67
| Professional | TC | $23.44 | $27.54 | $44.67 |