- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $398.11 / $512.86
| Professional | | $346.74 | $398.11 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $42.66 / $54.95
| Professional | 26 | $37.15 | $42.66 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $354.81 / $467.74
| Professional | TC | $309.03 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $218.78 / $446.68
| Professional | | $213.80 | $218.78 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $46.77
| Professional | 26 | $20.89 | $23.99 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $190.55 / $194.98 / $398.11
| Professional | TC | $190.55 | $194.98 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $33.88 / $63.10
| Facility | 26 | $31.62 | $33.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $223.87 / $645.65
| Professional | | $194.98 | $223.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $74.13
| Professional | 26 | $22.91 | $25.12 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $199.53 / $575.44
| Professional | TC | $173.78 | $199.53 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $512.86 / $645.65
| Professional | | $131.83 | $512.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $58.88 / $74.13
| Professional | 26 | $11.22 | $58.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $457.09 / $562.34
| Professional | TC | $120.23 | $457.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $398.11 / $691.83
| Professional | | $363.08 | $398.11 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $45.71 / $81.28
| Professional | 26 | $43.65 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $346.74 / $602.56
| Professional | TC | $323.59 | $346.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $323.59 / $1,023.29
| Professional | | $251.19 | $323.59 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $30.90 / $128.82
| Professional | 26 | $28.18 | $30.90 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $239.88 / $891.25
| Professional | TC | $223.87 | $239.88 | $891.25 |