- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $40.74 / $72.44
| Facility | 26 | $34.67 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $251.19 / $758.58
| Professional | | $169.82 | $251.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $47.86 / $109.65
| Professional | 26 | $33.11 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $436.52
| Professional | TC | $134.90 | $177.83 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $190.55
| Professional | | $134.90 | $158.49 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $56.23
| Professional | 26 | $28.18 | $34.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $181.97 / $478.63
| Professional | | $144.54 | $181.97 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $72.44
| Professional | 26 | $28.18 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $144.54 / $338.84
| Professional | TC | $117.49 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $223.87 / $281.84
| Professional | | $54.95 | $223.87 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.12 / $42.66 / $61.66
| Facility | 26 | $9.12 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $316.23 / $776.25
| Professional | | $181.97 | $316.23 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $52.48 / $131.83
| Professional | 26 | $32.36 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $630.96
| Professional | TC | $147.91 | $251.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $204.17 / $338.84
| Professional | | $177.83 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $275.42
| Professional | 26 | $41.69 | $61.66 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $223.87 / $331.13
| Professional | TC | $177.83 | $223.87 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $251.19 / $398.11
| Professional | | $147.91 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $52.48 / $79.43
| Professional | 26 | $26.92 | $52.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $117.49 / $199.53 / $323.59
| Professional | TC | $117.49 | $199.53 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | 26 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $234.42 / $323.59
| Professional | | $186.21 | $234.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $46.77 / $79.43
| Professional | 26 | $38.02 | $46.77 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $398.11
| Professional | TC | $208.93 | $309.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $275.42 / $436.52
| Professional | | $229.09 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $85.11
| Professional | 26 | $43.65 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $218.78 / $354.81
| Professional | TC | $186.21 | $218.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $199.53 / $616.60
| Professional | | $138.04 | $199.53 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $54.95 / $281.84
| Professional | 26 | $35.48 | $54.95 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $229.09 / $831.76
| Professional | TC | $154.88 | $229.09 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $97.72
| Facility | 26 | $26.92 | $44.67 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $223.87 / $478.63
| Professional | | $147.91 | $223.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $95.50
| Professional | 26 | $30.20 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $177.83 / $380.19
| Professional | TC | $123.03 | $177.83 | $380.19 |