- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $173.78
| Professional | | $28.18 | $44.67 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $14.13 / $28.84
| Professional | 26 | $8.91 | $14.13 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $81.28
| Professional | TC | $19.05 | $30.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $45.71
| Professional | | $14.13 | $14.13 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $17.38
| Facility | 26 | $14.13 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $85.11
| Professional | | $34.67 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $14.45 / $25.12
| Professional | 26 | $9.33 | $14.45 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $60.26
| Professional | TC | $25.12 | $34.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $51.29 / $93.33
| Professional | | $50.12 | $51.29 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $17.38
| Facility | 26 | $14.13 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $64.57 / $85.11
| Professional | | $41.69 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $14.45 / $21.38
| Professional | 26 | $9.55 | $14.45 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $47.86
| Professional | TC | $20.42 | $32.36 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $77.62
| Professional | | $31.62 | $36.31 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $10.96 / $74.13
| Professional | 26 | $9.77 | $10.96 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $25.12 / $42.66
| Professional | TC | $21.88 | $25.12 | $42.66 |