- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $72.44
| Facility | 26 | $52.48 | $70.79 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $269.15 / $812.83
| Professional | | $154.88 | $269.15 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $102.33 / $190.55
| Professional | 26 | $57.54 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $97.72 / $169.82 / $389.05
| Professional | TC | $97.72 | $169.82 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $204.17 / $257.04
| Professional | | $70.79 | $204.17 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $85.11
| Professional | 26 | $60.26 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $147.91 / $181.97
| Professional | TC | $131.83 | $147.91 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $263.03 / $501.19
| Professional | | $138.04 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $69.18 / $128.82
| Professional | 26 | $46.77 | $69.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $354.81
| Professional | TC | $89.13 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $190.55 / $302.00
| Professional | | $162.18 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $67.61 / $91.20
| Professional | 26 | $58.88 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $208.93
| Professional | TC | $104.71 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $245.47 / $436.52
| Professional | | $144.54 | $245.47 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $69.18 / $128.82
| Professional | 26 | $43.65 | $69.18 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $323.59
| Professional | TC | $109.65 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $181.97 / $263.03
| Professional | | $165.96 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $93.33
| Professional | 26 | $61.66 | $64.57 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $169.82
| Professional | TC | $104.71 | $117.49 | $169.82 |