- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $61.66 / $165.96
| Professional | | $39.81 | $61.66 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $20.89 / $66.07
| Professional | 26 | $15.14 | $20.89 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $97.72
| Professional | TC | $25.12 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $67.61 / $77.62
| Professional | | $20.42 | $67.61 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $20.89 / $26.92
| Professional | 26 | $17.78 | $20.89 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $63.10
| Professional | TC | $46.77 | $54.95 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $42.66 / $134.90
| Professional | | $24.55 | $42.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.28 / $14.45 / $41.69
| Professional | 26 | $0.28 | $14.45 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.69 / $29.51 / $102.33
| Professional | TC | $0.69 | $29.51 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $100.00 / $131.83
| Professional | | $89.13 | $100.00 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $42.66
| Professional | 26 | $25.12 | $30.20 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $72.44 / $95.50
| Professional | TC | $63.10 | $72.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $53.70 / $104.71
| Professional | | $38.02 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $45.71
| Professional | 26 | $15.85 | $20.89 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $34.67 / $64.57
| Professional | TC | $21.38 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $123.03 / $138.04
| Professional | | $57.54 | $123.03 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $38.02
| Professional | 26 | $21.88 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $87.10 / $100.00
| Professional | TC | $35.48 | $87.10 | $100.00 |