- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $125.89 / $251.19
| Professional | | $85.11 | $125.89 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $229.09
| Professional | 26 | $64.57 | $85.11 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $52.48
| Professional | TC | $20.89 | $32.36 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $134.90 / $251.19
| Professional | | $66.07 | $134.90 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $95.50 / $208.93
| Professional | 26 | $41.69 | $95.50 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $75.86
| Professional | TC | $25.12 | $37.15 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $239.88
| Professional | | $117.49 | $138.04 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $102.33 / $380.19
| Professional | 26 | $91.20 | $102.33 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $93.33
| Professional | TC | $28.18 | $35.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $239.88
| Professional | | $117.49 | $173.78 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $131.83 / $204.17
| Professional | 26 | $85.11 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $56.23
| Professional | TC | $30.90 | $43.65 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $97.72 / $223.87
| Professional | | $36.31 | $97.72 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $85.11 / $213.80
| Professional | | $69.18 | $85.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $54.95 / $128.82
| Professional | 26 | $51.29 | $54.95 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $29.51 / $53.70
| Professional | TC | $15.85 | $29.51 | $53.70 |