- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $338.84 / $977.24
| Professional | | $72.44 | $338.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $70.79 / $316.23
| Professional | 26 | $25.12 | $70.79 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $223.87
| Professional | TC | $42.66 | $69.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $109.65
| Professional | 26 | $16.60 | $16.60 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $165.96 / $229.09
| Professional | | $44.67 | $165.96 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $54.95 / $74.13
| Professional | 26 | $16.22 | $54.95 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $109.65 / $147.91
| Professional | TC | $29.51 | $109.65 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $112.20 / $295.12
| Professional | | $51.29 | $112.20 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $134.90
| Professional | 26 | $17.38 | $34.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $72.44 / $204.17
| Professional | TC | $33.88 | $72.44 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $346.74
| Professional | | $107.15 | $151.36 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $102.33
| Professional | 26 | $38.02 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $138.04 / $245.47
| Professional | TC | $89.13 | $138.04 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $398.11
| Professional | | $85.11 | $144.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $53.70 / $117.49
| Professional | 26 | $36.31 | $53.70 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $213.80
| Professional | TC | $74.13 | $100.00 | $213.80 |