- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $173.78 / $177.83
| Facility | | $141.25 | $173.78 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | 26 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $186.21 / $186.21
| Facility | TC | $81.28 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $93.33 / $141.25
| Professional | | $41.69 | $93.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $41.69 / $61.66
| Professional | 26 | $16.98 | $41.69 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $47.86 / $81.28
| Professional | TC | $23.99 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $128.82 / $134.90
| Professional | | $112.20 | $128.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $52.48 / $54.95
| Professional | 26 | $46.77 | $52.48 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $75.86 / $79.43
| Professional | TC | $66.07 | $75.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $53.70
| Professional | | $52.48 | $52.48 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | 26 | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $31.62
| Professional | TC | $29.51 | $29.51 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $123.03 / $177.83
| Facility | | $64.57 | $123.03 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | 26 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $186.21 / $186.21
| Facility | TC | $81.28 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $114.82 / $120.23
| Professional | | $87.10 | $114.82 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $45.71 / $61.66
| Professional | 26 | $30.20 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $81.28
| Professional | TC | $39.81 | $64.57 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $120.23 / $120.23
| Professional | | $112.20 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | 26 | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $72.44
| Professional | TC | $64.57 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $165.96
| Professional | | $61.66 | $61.66 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $91.20
| Professional | 26 | $25.12 | $25.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $100.00
| Professional | TC | $36.31 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $95.50
| Professional | | $40.74 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $28.84 / $40.74
| Professional | 26 | $17.38 | $28.84 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $54.95
| Professional | TC | $23.99 | $27.54 | $54.95 |