- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $75.86 / $275.42
| Facility | 26 | $37.15 | $75.86 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $199.53 / $309.03
| Professional | | $162.18 | $199.53 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $162.18 / $316.23
| Professional | TC | $128.82 | $162.18 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $269.15 / $407.38
| Professional | | $194.98 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $213.80 / $323.59
| Professional | TC | $154.88 | $213.80 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $275.42 / $912.01
| Professional | | $169.82 | $275.42 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $281.84
| Professional | TC | $186.21 | $204.17 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $295.12 / $478.63
| Professional | | $162.18 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $239.88 / $380.19
| Professional | TC | $141.25 | $239.88 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $281.84 / $295.12
| Professional | | $199.53 | $281.84 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $54.95 / $57.54
| Professional | 26 | $41.69 | $54.95 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $234.42
| Professional | TC | $162.18 | $223.87 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $354.81 / $436.52
| Professional | | $309.03 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $67.61 / $91.20
| Professional | 26 | $64.57 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $263.03 / $1,096.48
| Professional | | $54.95 | $263.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $257.04 / $426.58
| Professional | TC | $194.98 | $257.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $323.59 / $512.86
| Professional | | $194.98 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $154.88 / $263.03 / $416.87
| Professional | TC | $154.88 | $263.03 | $416.87 |