- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $218.78 / $346.74
| Professional | | $199.53 | $218.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $104.71
| Professional | 26 | $26.92 | $38.02 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $158.49 / $181.97 / $630.96
| Professional | TC | $158.49 | $181.97 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $53.70 / $53.70
| Professional | 26 | $19.05 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $181.97 / $389.05
| Professional | | $141.25 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $23.44 / $74.13
| Professional | 26 | $18.62 | $23.44 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $154.88 / $331.13
| Professional | TC | $123.03 | $154.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $245.47 / $467.74
| Professional | | $114.82 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $39.81 / $77.62
| Professional | 26 | $19.05 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $190.55 / $398.11
| Professional | TC | $89.13 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $190.55 / $457.09
| Professional | | $102.33 | $190.55 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $39.81 / $93.33
| Professional | 26 | $19.05 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $389.05
| Professional | TC | $89.13 | $147.91 | $389.05 |
- 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
- $257.04 / $295.12 / $416.87
| Professional | | $257.04 | $295.12 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $50.12 / $67.61
| Professional | 26 | $40.74 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $251.19 / $346.74
| Professional | TC | $204.17 | $251.19 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $281.84 / $512.86
| Professional | | $134.90 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $44.67 / $72.44
| Professional | 26 | $26.92 | $44.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $114.82 / $239.88 / $436.52
| Professional | TC | $114.82 | $239.88 | $436.52 |