- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $104.71
| Professional | | $28.84 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $33.88
| Professional | 26 | $12.02 | $15.85 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $30.90 / $51.29
| Professional | TC | $15.85 | $30.90 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Facility | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $173.78
| Professional | | $69.18 | $69.18 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $63.10
| Professional | 26 | $20.42 | $20.42 | $63.10 |
- 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
- $51.29 / $91.20 / $151.36
| Professional | | $51.29 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $21.88 / $46.77
| Professional | 26 | $19.95 | $21.88 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $52.48 / $89.13
| Professional | TC | $29.51 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $15.49 / $15.49
| Professional | 26 | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | TC | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $114.82
| Professional | | $41.69 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $20.89 / $38.90
| Professional | 26 | $15.49 | $20.89 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $91.20
| Professional | TC | $25.12 | $34.67 | $91.20 |