- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $162.18
| Professional | | $46.77 | $46.77 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $51.29
| Professional | 26 | $15.14 | $15.14 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $109.65
| Professional | TC | $30.90 | $30.90 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $120.23 / $123.03
| Professional | | $83.18 | $120.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $38.90
| Professional | 26 | $25.70 | $38.02 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $85.11
| Professional | TC | $57.54 | $83.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $147.91 / $186.21
| Professional | | $95.50 | $147.91 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $46.77 / $56.23
| Professional | 26 | $37.15 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $131.83
| Professional | TC | $57.54 | $104.71 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $72.44 / $467.74
| Professional | | $38.90 | $72.44 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $186.21
| Professional | 26 | $22.91 | $26.30 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $46.77 / $309.03
| Professional | TC | $25.70 | $46.77 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $147.91 / $204.17
| Professional | | $114.82 | $147.91 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $46.77 / $61.66
| Professional | 26 | $42.66 | $46.77 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $104.71 / $141.25
| Professional | TC | $67.61 | $104.71 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $186.21 / $204.17
| Professional | | $162.18 | $186.21 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $56.23 / $61.66
| Professional | 26 | $54.95 | $56.23 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $131.83 / $141.25
| Professional | TC | $109.65 | $131.83 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $67.61 / $128.82
| Professional | | $48.98 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $61.66
| Professional | 26 | $22.91 | $25.12 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $44.67 / $89.13
| Professional | TC | $25.70 | $44.67 | $89.13 |