- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $123.03 / $229.09
| Facility | 26 | $61.66 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $331.13
| Professional | | $107.15 | $134.90 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $131.83
| Professional | 26 | $53.70 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $154.88
| Professional | TC | $52.48 | $63.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $165.96
| Professional | | $125.89 | $125.89 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $117.49 / $223.87
| Professional | | $100.00 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $61.66 / $112.20
| Professional | 26 | $52.48 | $61.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $112.20
| Professional | TC | $48.98 | $57.54 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $67.61 / $95.50
| Facility | 26 | $14.45 | $67.61 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $181.97 / $288.40
| Professional | | $112.20 | $181.97 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $120.23
| Professional | 26 | $56.23 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $107.15 / $181.97
| Professional | TC | $54.95 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $177.83 / $251.19
| Professional | | $144.54 | $177.83 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $87.10 / $125.89
| Professional | 26 | $69.18 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $125.89
| Professional | TC | $74.13 | $91.20 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $169.82 / $251.19
| Professional | | $125.89 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $109.65
| Professional | 26 | $58.88 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $151.36
| Professional | TC | $61.66 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $97.72
| Professional | 26 | $63.10 | $85.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $165.96
| Professional | | $125.89 | $125.89 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $87.10 / $181.97
| Facility | 26 | $57.54 | $87.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $138.04 / $309.03
| Professional | | $107.15 | $138.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $138.04
| Professional | 26 | $53.70 | $64.57 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $158.49
| Professional | TC | $52.48 | $67.61 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $239.88 / $380.19
| Professional | | $186.21 | $239.88 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $77.62
| Facility | 26 | $57.54 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $173.78
| Professional | | $72.44 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $57.54 / $77.62
| Professional | 26 | $56.23 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $54.95 / $147.91
| Professional | TC | $53.70 | $54.95 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $275.42
| Professional | | $109.65 | $158.49 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $69.18 / $123.03
| Professional | 26 | $53.70 | $69.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $169.82
| Professional | TC | $53.70 | $81.28 | $169.82 |