- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $331.13 / $758.58
| Professional | | $234.42 | $331.13 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $457.09
| Professional | 26 | $45.71 | $70.79 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $275.42 / $512.86
| Professional | TC | $204.17 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | 26 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $239.88 / $630.96
| Professional | | $85.11 | $239.88 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $60.26 / $125.89
| Professional | 26 | $26.30 | $60.26 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $158.49 / $524.81
| Professional | TC | $58.88 | $158.49 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $616.60
| Professional | | $239.88 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $109.65
| Professional | 26 | $58.88 | $75.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $295.12 / $512.86
| Professional | TC | $165.96 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $199.53 / $575.44
| Professional | | $102.33 | $199.53 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $34.67 / $169.82
| Professional | 26 | $30.20 | $34.67 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $169.82 / $426.58
| Professional | TC | $70.79 | $169.82 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $281.84 / $281.84 / $281.84
| Facility | 26 | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $398.11 / $2,570.40
| Professional | | $218.78 | $398.11 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $72.44 / $398.11
| Professional | 26 | $40.74 | $72.44 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $331.13 / $2,187.76
| Professional | TC | $151.36 | $331.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $398.11 / $707.95
| Professional | | $234.42 | $398.11 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $134.90
| Professional | 26 | $40.74 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $194.98 / $331.13 / $588.84
| Professional | TC | $194.98 | $331.13 | $588.84 |