- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $128.82 / $269.15
| Professional | | $97.72 | $128.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $38.02 / $83.18
| Professional | 26 | $25.12 | $38.02 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $87.10 / $194.98
| Professional | TC | $64.57 | $87.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $165.96
| Professional | | $44.67 | $44.67 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $54.95
| Facility | 26 | $44.67 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $245.47
| Professional | | $112.20 | $151.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $42.66 / $66.07
| Professional | 26 | $32.36 | $42.66 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $109.65 / $177.83
| Professional | TC | $79.43 | $109.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $181.97 / $323.59
| Professional | | $173.78 | $181.97 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $54.95
| Facility | 26 | $44.67 | $44.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $245.47
| Professional | | $131.83 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $58.88
| Professional | 26 | $32.36 | $44.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $151.36
| Professional | TC | $79.43 | $120.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $112.20 / $213.80
| Professional | | $109.65 | $112.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $33.88 / $83.18
| Professional | 26 | $30.20 | $33.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $81.28 / $138.04
| Professional | TC | $77.62 | $81.28 | $138.04 |