- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $645.65
| Professional | | $190.55 | $331.13 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $72.44 / $436.52
| Professional | 26 | $45.71 | $72.44 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $131.83 / $263.03 / $436.52
| Professional | TC | $131.83 | $263.03 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $60.26 / $81.28
| Professional | 26 | $29.51 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $575.44 / $575.44
| Professional | | $104.71 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $389.05
| Professional | TC | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $363.08 / $741.31
| Professional | | $66.07 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $199.53 / $660.69
| Professional | | $107.15 | $199.53 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $147.91
| Professional | 26 | $28.18 | $37.15 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $158.49 / $446.68
| Professional | TC | $72.44 | $158.49 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $316.23 / $912.01
| Professional | | $194.98 | $316.23 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $229.09
| Professional | 26 | $48.98 | $74.13 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $263.03 / $758.58
| Professional | TC | $109.65 | $263.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $190.55 / $478.63
| Professional | | $107.15 | $190.55 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $33.11 / $83.18
| Professional | 26 | $28.18 | $33.11 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $158.49 / $331.13
| Professional | TC | $72.44 | $158.49 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $537.03
| Professional | | $134.90 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $181.97
| Professional | 26 | $40.74 | $67.61 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $208.93 / $446.68
| Professional | TC | $93.33 | $208.93 | $446.68 |