- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $194.98 / $363.08
| Professional | | $151.36 | $194.98 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $144.54
| Professional | 26 | $77.62 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $162.18
| Professional | TC | $72.44 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $141.25 / $416.87
| Professional | | $109.65 | $141.25 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $199.53
| Professional | 26 | $51.29 | $67.61 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $74.13 / $165.96
| Professional | TC | $58.88 | $74.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $229.09 / $436.52
| Professional | | $109.65 | $229.09 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $117.49 / $223.87
| Professional | 26 | $56.23 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $208.93
| Professional | TC | $48.98 | $104.71 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $218.78 / $389.05
| Professional | | $109.65 | $218.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $112.20 / $223.87
| Professional | 26 | $56.23 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $51.29 / $102.33 / $173.78
| Professional | TC | $51.29 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $263.03 / $426.58
| Professional | | $223.87 | $263.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $134.90 / $213.80
| Professional | 26 | $117.49 | $134.90 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $223.87
| Professional | TC | $107.15 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $229.09 / $389.05
| Professional | | $138.04 | $229.09 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $131.83 / $218.78
| Professional | 26 | $79.43 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $100.00 / $190.55
| Professional | TC | $58.88 | $100.00 | $190.55 |