- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $102.33
| Facility | 26 | $23.44 | $35.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $131.83 / $288.40
| Professional | | $93.33 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $239.88
| Professional | TC | $77.62 | $112.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $107.15 / $275.42
| Professional | | $85.11 | $107.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $81.28 / $223.87
| Professional | TC | $66.07 | $81.28 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $162.18 / $194.98
| Professional | | $33.11 | $162.18 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $26.30 / $38.02
| Facility | 26 | $5.62 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $169.82 / $549.54
| Professional | | $104.71 | $169.82 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $144.54 / $524.81
| Professional | TC | $83.18 | $144.54 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $302.00
| Professional | | $151.36 | $194.98 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $173.78 / $251.19
| Professional | TC | $131.83 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $331.13
| Professional | | $95.50 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $147.91 / $275.42
| Professional | TC | $81.28 | $147.91 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $177.83 / $371.54
| Professional | | $151.36 | $177.83 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $144.54 / $309.03
| Professional | TC | $120.23 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $186.21 / $524.81
| Professional | | $114.82 | $186.21 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $467.74
| Professional | TC | $95.50 | $162.18 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $79.43
| Facility | 26 | $19.05 | $26.92 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $331.13
| Professional | | $95.50 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $147.91 / $275.42
| Professional | TC | $81.28 | $147.91 | $275.42 |