- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $269.15
| Professional | | $72.44 | $107.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $18.20 / $46.77
| Professional | 26 | $14.13 | $18.20 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $199.53
| Professional | TC | $57.54 | $89.13 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $144.54 / $758.58
| Professional | | $69.18 | $144.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $204.17
| Professional | 26 | $16.60 | $25.12 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $128.82 / $630.96
| Professional | TC | $56.23 | $128.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $154.88 / $302.00
| Professional | | $69.18 | $154.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $28.18 / $51.29
| Professional | 26 | $15.85 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $131.83 / $257.04
| Professional | TC | $53.70 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $131.83 / $218.78
| Professional | | $23.44 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $316.23
| Professional | | $117.49 | $177.83 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $51.29
| Professional | 26 | $19.05 | $28.18 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $269.15
| Professional | TC | $114.82 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $144.54 / $758.58
| Professional | | $69.18 | $144.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $25.12 / $204.17
| Professional | 26 | $16.60 | $25.12 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $128.82 / $630.96
| Professional | TC | $56.23 | $128.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $331.13
| Professional | | $74.13 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $52.48
| Professional | 26 | $18.62 | $25.12 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $125.89 / $281.84
| Professional | TC | $60.26 | $125.89 | $281.84 |