- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $331.13 / $977.24
| Professional | | $204.17 | $331.13 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $107.15 / $660.69
| Professional | 26 | $39.81 | $107.15 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $275.42 / $707.95
| Professional | TC | $141.25 | $275.42 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $812.83
| Professional | | $165.96 | $165.96 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $147.91
| Professional | 26 | $26.92 | $26.92 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $660.69
| Professional | TC | $141.25 | $141.25 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $295.12 / $588.84
| Professional | | $91.20 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $169.82 / $245.47
| Facility | 26 | $36.31 | $169.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $398.11 / $1,230.27
| Professional | | $128.82 | $398.11 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $74.13 / $204.17
| Professional | 26 | $34.67 | $74.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $316.23 / $954.99
| Professional | TC | $91.20 | $316.23 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $371.54 / $602.56
| Professional | | $251.19 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $54.95 / $89.13
| Professional | 26 | $38.02 | $54.95 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $316.23 / $512.86
| Professional | TC | $208.93 | $316.23 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $512.86 / $776.25
| Professional | | $177.83 | $512.86 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $123.03
| Professional | 26 | $52.48 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $112.20 / $380.19 / $645.65
| Professional | TC | $112.20 | $380.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $123.03 / $131.83
| Professional | 26 | $79.43 | $123.03 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $478.63
| Professional | | $398.11 | $398.11 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $74.13
| Professional | 26 | $61.66 | $61.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $398.11
| Professional | TC | $331.13 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $794.33
| Professional | | $199.53 | $371.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $125.89
| Professional | 26 | $33.11 | $63.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $331.13 / $691.83
| Professional | TC | $169.82 | $331.13 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $457.09 / $831.76
| Professional | | $177.83 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $134.90
| Professional | 26 | $51.29 | $72.44 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $354.81 / $691.83
| Professional | TC | $107.15 | $354.81 | $691.83 |