- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $173.78 / $208.93
| Professional | | $75.86 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $67.61 / $79.43
| Professional | 26 | $28.84 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $125.89
| Professional | TC | $45.71 | $64.57 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $144.54 / $144.54
| Professional | | $123.03 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $57.54 / $57.54
| Professional | 26 | $48.98 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $89.13
| Professional | TC | $75.86 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $134.90 / $398.11
| Professional | | $123.03 | $134.90 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $51.29 / $151.36
| Professional | 26 | $27.54 | $51.29 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $83.18 / $177.83
| Professional | TC | $74.13 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $97.72 / $398.11
| Professional | | $95.50 | $97.72 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $38.90 / $151.36
| Professional | 26 | $36.31 | $38.90 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $69.18
| Professional | TC | $58.88 | $58.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $234.42
| Professional | | $93.33 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $46.77 / $93.33
| Professional | 26 | $37.15 | $46.77 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $70.79 / $144.54
| Professional | TC | $58.88 | $70.79 | $144.54 |