- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $48.98
| Facility | 26 | $23.99 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $281.84 / $478.63
| Professional | | $204.17 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $91.20
| Professional | 26 | $25.70 | $41.69 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $245.47 / $436.52
| Professional | TC | $181.97 | $245.47 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $575.44
| Professional | | $234.42 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $72.44
| Professional | 26 | $29.51 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | TC | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $229.09 / $316.23
| Professional | | $28.84 | $229.09 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $154.88 / $338.84
| Professional | | $147.91 | $154.88 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $213.80 / $213.80
| Professional | 26 | $34.67 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $588.84
| Professional | | $229.09 | $331.13 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $79.43
| Professional | 26 | $30.90 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $295.12 / $512.86
| Professional | TC | $199.53 | $295.12 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | 26 | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,511.89 / $2,511.89
| Professional | | $2,041.74 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $275.42 / $295.12 / $295.12
| Professional | 26 | $275.42 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $1,778.28 / $2,187.76 / $2,187.76
| Professional | TC | $1,778.28 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $48.98
| Facility | 26 | $24.55 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $416.87 / $758.58
| Professional | | $234.42 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $53.70 / $104.71
| Professional | 26 | $27.54 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $363.08 / $676.08
| Professional | TC | $204.17 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $239.88
| Professional | | $32.36 | $33.11 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $316.23 / $562.34
| Professional | | $229.09 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $72.44
| Professional | 26 | $29.51 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $501.19
| Professional | TC | $199.53 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $309.03 / $489.78
| Professional | | $218.78 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $38.90 / $58.88
| Professional | 26 | $31.62 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $275.42 / $426.58
| Professional | TC | $186.21 | $275.42 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $288.40
| Professional | | $275.42 | $275.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $36.31
| Professional | 26 | $34.67 | $34.67 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $251.19
| Professional | TC | $239.88 | $239.88 | $251.19 |