- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $181.97
| Professional | | $46.77 | $66.07 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $26.92 / $69.18
| Professional | 26 | $16.98 | $26.92 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $354.81
| Professional | TC | $28.18 | $39.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $22.91 / $25.12
| Professional | 26 | $10.23 | $22.91 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $61.66 / $128.82
| Professional | | $29.51 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $22.39 / $48.98
| Professional | 26 | $11.48 | $22.39 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $38.90 / $85.11
| Professional | TC | $18.20 | $38.90 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $79.43 / $107.15
| Facility | | $52.48 | $79.43 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $81.28 / $407.38
| Professional | | $38.02 | $81.28 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $32.36 / $245.47
| Professional | 26 | $14.13 | $32.36 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $51.29 / $269.15
| Professional | TC | $23.99 | $51.29 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $30.20 / $44.67
| Facility | | $13.80 | $30.20 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $67.61 / $89.13
| Professional | | $38.02 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $25.70 / $33.11
| Professional | 26 | $14.13 | $25.70 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $54.95
| Professional | TC | $23.99 | $39.81 | $54.95 |