- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $131.83 / $676.08
| Professional | | $75.86 | $131.83 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $169.82 / $707.95
| Professional | 26 | $39.81 | $169.82 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $75.86 / $302.00
| Professional | TC | $48.98 | $75.86 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $117.49
| Professional | | $81.28 | $85.11 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $30.20 / $41.69
| Professional | 26 | $29.51 | $30.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $54.95 / $74.13
| Professional | TC | $52.48 | $54.95 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $114.82 / $186.21
| Professional | | $57.54 | $114.82 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $43.65 / $69.18
| Professional | 26 | $19.95 | $43.65 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $58.88 / $114.82
| Professional | TC | $33.11 | $58.88 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $128.82 / $213.80
| Facility | | $91.20 | $128.82 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 26 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $109.65 / $758.58
| Professional | | $69.18 | $109.65 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $43.65 / $309.03
| Professional | 26 | $26.30 | $43.65 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $61.66 / $512.86
| Professional | TC | $38.90 | $61.66 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $67.61 / $114.82
| Facility | | $45.71 | $67.61 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $81.28 / $181.97
| Professional | | $69.18 | $81.28 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $83.18
| Professional | 26 | $23.99 | $33.11 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $50.12 / $117.49
| Professional | TC | $38.90 | $50.12 | $117.49 |