- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $331.13
| Professional | | $81.28 | $117.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $87.10 / $213.80
| Professional | 26 | $67.61 | $87.10 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $61.66
| Professional | TC | $20.89 | $26.92 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $100.00 / $223.87
| Professional | | $63.10 | $100.00 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $74.13 / $144.54
| Professional | 26 | $42.66 | $74.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $57.54
| Professional | TC | $16.98 | $26.92 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $223.87 / $323.59
| Professional | | $112.20 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $83.18 / $165.96 / $234.42
| Professional | 26 | $83.18 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $58.88 / $85.11
| Professional | TC | $29.51 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $204.17 / $371.54
| Professional | | $102.33 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $275.42
| Professional | 26 | $87.10 | $151.36 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $61.66 / $95.50
| Professional | TC | $44.67 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $63.10 / $218.78
| Professional | | $61.66 | $63.10 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $223.87 / $346.74
| Professional | | $91.20 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $89.13 / $251.19
| Professional | 26 | $45.71 | $89.13 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $107.15
| Professional | TC | $19.95 | $32.36 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $229.09 / $371.54
| Professional | | $158.49 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $177.83 / $275.42
| Professional | 26 | $120.23 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $95.50
| Professional | TC | $38.02 | $54.95 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $91.20 / $354.81
| Professional | | $69.18 | $91.20 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $67.61 / $269.15
| Professional | 26 | $53.70 | $67.61 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $30.20 / $93.33
| Professional | TC | $15.85 | $30.20 | $93.33 |