- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $77.62 / $112.20
| Facility | 26 | $70.79 | $77.62 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $331.13
| Professional | | $125.89 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $158.49
| Professional | 26 | $70.79 | $81.28 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $61.66 / $91.20
| Professional | TC | $51.29 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $151.36 / $186.21
| Professional | | $123.03 | $151.36 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $77.62 / $97.72
| Professional | 26 | $67.61 | $77.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $57.54
| Professional | TC | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $165.96
| Professional | | $63.10 | $107.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $158.49 / $245.47
| Professional | | $123.03 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $109.65
| Professional | 26 | $77.62 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $186.21 / $295.12
| Professional | | $138.04 | $186.21 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $165.96
| Professional | 26 | $77.62 | $104.71 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $125.89
| Professional | TC | $58.88 | $81.28 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | 26 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,096.48 / $1,096.48
| Professional | | $870.96 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $630.96
| Professional | 26 | $501.19 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $467.74 / $467.74
| Professional | TC | $380.19 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $112.20
| Facility | 26 | $60.26 | $89.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $151.36 / $288.40
| Professional | | $125.89 | $151.36 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $154.88
| Professional | 26 | $70.79 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $63.10 / $112.20
| Professional | TC | $51.29 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $43.65 / $112.20
| Professional | | $32.36 | $43.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $151.36 / $309.03
| Professional | | $67.61 | $151.36 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $316.23
| Professional | | $131.83 | $186.21 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $162.18
| Professional | 26 | $75.86 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $79.43 / $125.89
| Professional | TC | $53.70 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $158.49 / $251.19
| Professional | | $120.23 | $158.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $141.25
| Professional | 26 | $66.07 | $87.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $69.18 / $109.65
| Professional | TC | $52.48 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $141.25 / $169.82
| Professional | | $102.33 | $141.25 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $97.72
| Professional | 26 | $58.88 | $81.28 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $72.44
| Professional | TC | $41.69 | $61.66 | $72.44 |