- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $194.98 / $316.23
| Professional | | $91.20 | $194.98 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $112.20
| Professional | 26 | $18.20 | $23.99 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $173.78 / $323.59
| Professional | TC | $134.90 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $173.78 / $354.81
| Professional | | $70.79 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $19.05 / $51.29
| Professional | 26 | $11.75 | $19.05 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $154.88 / $316.23
| Professional | TC | $54.95 | $154.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $371.54 / $537.03
| Professional | | $186.21 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $43.65 / $63.10
| Professional | 26 | $21.88 | $43.65 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $331.13 / $478.63
| Professional | TC | $165.96 | $331.13 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $338.84 / $660.69
| Professional | | $213.80 | $338.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $39.81 / $75.86
| Professional | 26 | $33.11 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $302.00 / $588.84
| Professional | TC | $186.21 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $331.13 / $616.60
| Professional | | $154.88 | $331.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $23.99 / $75.86
| Professional | 26 | $13.18 | $23.99 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $177.83 / $512.86
| Professional | TC | $54.95 | $177.83 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $416.87 / $645.65
| Professional | | $257.04 | $416.87 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $72.44
| Professional | 26 | $33.11 | $50.12 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $575.44
| Professional | TC | $213.80 | $363.08 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $181.97 / $630.96
| Professional | | $109.65 | $181.97 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $18.20 / $75.86
| Professional | 26 | $15.49 | $18.20 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $158.49 / $562.34
| Professional | TC | $93.33 | $158.49 | $562.34 |