- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $72.44 / $112.20
| Professional | | $33.88 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $26.92 / $33.11
| Professional | 26 | $12.02 | $26.92 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $77.62 / $89.13
| Professional | TC | $33.11 | $77.62 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $91.20
| Facility | 26 | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $229.09
| Professional | | $67.61 | $67.61 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $54.95
| Professional | 26 | $19.95 | $19.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $57.54
| Professional | TC | $48.98 | $48.98 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $70.79 / $165.96
| Professional | | $61.66 | $70.79 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $21.38 / $47.86
| Professional | 26 | $18.62 | $21.38 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $48.98 / $107.15
| Professional | TC | $39.81 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $16.22
| Professional | 26 | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | TC | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $134.90
| Professional | | $51.29 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.05 / $33.11
| Professional | 26 | $14.13 | $19.05 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $102.33
| Professional | TC | $37.15 | $51.29 | $102.33 |