- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $645.65
| Professional | | $83.18 | $120.23 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $54.95 / $257.04
| Professional | 26 | $25.70 | $54.95 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $467.74
| Professional | TC | $58.88 | $85.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $104.71 / $144.54
| Professional | | $102.33 | $104.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.90 / $42.66
| Professional | 26 | $30.20 | $30.90 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $102.33
| Professional | TC | $72.44 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $147.91 / $223.87
| Professional | | $69.18 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $43.65 / $89.13
| Professional | 26 | $19.50 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $93.33 / $138.04
| Professional | TC | $41.69 | $93.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Facility | 26 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $1,071.52
| Professional | | $79.43 | $134.90 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $41.69 / $389.05
| Professional | 26 | $24.55 | $41.69 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $794.33
| Professional | TC | $54.95 | $91.20 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $125.89 / $199.53
| Professional | | $79.43 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $38.90 / $69.18
| Professional | 26 | $24.55 | $38.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $83.18 / $144.54
| Professional | TC | $54.95 | $83.18 | $144.54 |