- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $79.43 / $125.89
| Professional | | $40.74 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $15.85 / $46.77
| Professional | 26 | $7.76 | $15.85 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $95.50
| Professional | TC | $25.70 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $67.61
| Professional | | $22.91 | $22.91 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.84
| Facility | 26 | $22.91 | $22.91 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $77.62 / $114.82
| Professional | | $54.95 | $77.62 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $14.79 / $37.15
| Professional | 26 | $8.13 | $14.79 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $61.66 / $89.13
| Professional | TC | $44.67 | $61.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $75.86 / $112.20
| Professional | | $72.44 | $75.86 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $28.84
| Facility | 26 | $22.91 | $22.91 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $95.50 / $114.82
| Professional | | $61.66 | $95.50 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $20.42 / $34.67
| Professional | 26 | $11.75 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $67.61
| Professional | TC | $28.84 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $67.61 / $104.71
| Professional | | $42.66 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $15.85 / $43.65
| Professional | 26 | $8.51 | $15.85 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $89.13
| Professional | TC | $26.92 | $42.66 | $89.13 |