- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $295.12 / $467.74
| Professional | | $144.54 | $295.12 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $107.15 / $239.88
| Professional | 26 | $72.44 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $125.89 / $186.21
| Professional | TC | $67.61 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $436.52 / $645.65
| Professional | | $331.13 | $436.52 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $229.09 / $354.81
| Professional | 26 | $173.78 | $229.09 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $208.93 / $309.03
| Professional | TC | $131.83 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $239.88 / $323.59
| Professional | | $112.20 | $239.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $186.21
| Professional | 26 | $63.10 | $123.03 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $120.23 / $154.88
| Professional | TC | $47.86 | $120.23 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $234.42 / $363.08
| Facility | 26 | $181.97 | $234.42 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $524.81 / $676.08
| Professional | | $316.23 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $251.19 / $331.13
| Professional | 26 | $181.97 | $251.19 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $245.47 / $354.81
| Professional | TC | $128.82 | $245.47 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $79.43
| Professional | | $32.36 | $33.11 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $223.87 / $257.04
| Professional | | $154.88 | $223.87 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $524.81 / $630.96
| Professional | | $316.23 | $524.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $162.18 / $263.03 / $331.13
| Professional | 26 | $162.18 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $257.04 / $309.03
| Professional | TC | $158.49 | $257.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $446.68 / $645.65
| Professional | | $331.13 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $173.78 / $229.09 / $354.81
| Professional | 26 | $173.78 | $229.09 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $213.80 / $288.40
| Professional | TC | $131.83 | $213.80 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $234.42 / $562.34
| Professional | | $141.25 | $234.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $123.03 / $309.03
| Professional | 26 | $72.44 | $123.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $107.15 / $245.47
| Professional | TC | $64.57 | $107.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $123.03
| Professional | 26 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Professional | TC | $134.90 | $134.90 | $134.90 |