- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $64.57 / $588.84
| Professional | | $46.77 | $64.57 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $169.82
| Professional | 26 | $15.85 | $20.89 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $42.66 / $426.58
| Professional | TC | $30.20 | $42.66 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Professional | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $125.89
| Professional | | $30.90 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $25.12 / $48.98
| Professional | 26 | $12.02 | $25.12 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $34.67 / $77.62
| Professional | TC | $17.78 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $89.13 / $467.74
| Professional | | $41.69 | $89.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $36.31 / $186.21
| Professional | 26 | $15.85 | $36.31 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $56.23 / $309.03
| Professional | TC | $25.70 | $56.23 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $67.61 / $97.72
| Professional | | $41.69 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $37.15
| Professional | 26 | $15.85 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $41.69 / $60.26
| Professional | TC | $25.70 | $41.69 | $60.26 |