- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $977.24
| Professional | | $208.93 | $354.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $954.99
| Professional | 26 | $40.74 | $60.26 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $281.84 / $741.31
| Professional | TC | $141.25 | $281.84 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $338.84 / $398.11
| Professional | | $58.88 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $53.70 / $67.61
| Professional | 26 | $50.12 | $53.70 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $302.00 / $389.05
| Professional | TC | $288.40 | $302.00 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $234.42 / $660.69
| Professional | | $100.00 | $234.42 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.71 / $36.31 / $104.71
| Professional | 26 | $0.71 | $36.31 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.80 / $190.55 / $562.34
| Professional | TC | $3.80 | $190.55 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $489.78 / $645.65
| Professional | | $407.38 | $489.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $95.50
| Professional | 26 | $63.10 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $416.87 / $549.54
| Professional | TC | $346.74 | $416.87 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $323.59 / $562.34
| Professional | | $151.36 | $323.59 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $109.65
| Professional | 26 | $41.69 | $53.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $275.42 / $467.74
| Professional | TC | $109.65 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $645.65
| Professional | | $338.84 | $575.44 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $95.50
| Professional | 26 | $54.95 | $85.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $562.34
| Professional | TC | $281.84 | $489.78 | $562.34 |