- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $218.78
| Facility | 26 | $60.26 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $288.40 / $977.24
| Professional | | $120.23 | $288.40 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $213.80 / $851.14
| Professional | 26 | $58.88 | $213.80 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $102.33 / $208.93
| Professional | TC | $60.26 | $102.33 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $128.82
| Professional | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | 26 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $371.54
| Professional | | $107.15 | $138.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $151.36
| Professional | 26 | $50.12 | $64.57 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $74.13 / $213.80
| Professional | TC | $57.54 | $74.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $91.20 / $177.83
| Professional | | $85.11 | $91.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $69.18 / $97.72
| Facility | 26 | $14.79 | $69.18 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $645.65
| Professional | | $112.20 | $234.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $95.50 / $295.12
| Professional | 26 | $52.48 | $95.50 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $134.90 / $316.23
| Professional | TC | $60.26 | $134.90 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $177.83 / $269.15
| Professional | | $128.82 | $177.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $128.82
| Professional | 26 | $60.26 | $83.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $95.50 / $144.54
| Professional | TC | $69.18 | $95.50 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $257.04
| Professional | | $95.50 | $134.90 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $74.13 / $123.03
| Professional | 26 | $41.69 | $74.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $131.83
| Professional | TC | $52.48 | $81.28 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Professional | 26 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $141.25 / $263.03
| Professional | | $117.49 | $141.25 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $144.54
| Professional | 26 | $67.61 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $281.84
| Professional | | $147.91 | $177.83 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $85.11 / $131.83
| Professional | 26 | $69.18 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $89.13 / $151.36
| Professional | TC | $77.62 | $89.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $165.96 / $407.38
| Professional | | $104.71 | $165.96 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $194.98
| Professional | 26 | $50.12 | $77.62 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $223.87
| Professional | TC | $57.54 | $91.20 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $199.53
| Facility | 26 | $50.12 | $64.57 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $158.49 / $363.08
| Professional | | $102.33 | $158.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $77.62 / $186.21
| Professional | 26 | $50.12 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $81.28 / $204.17
| Professional | TC | $52.48 | $81.28 | $204.17 |