- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $56.23 / $128.82
| Professional | | $50.12 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $38.90
| Professional | 26 | $16.98 | $23.44 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $89.13
| Professional | TC | $31.62 | $37.15 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $66.07 / $89.13
| Professional | | $24.55 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $52.48 / $125.89
| Professional | | $25.70 | $52.48 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $31.62 / $43.65
| Professional | 26 | $11.48 | $31.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $25.70 / $79.43
| Professional | TC | $14.13 | $25.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $85.11 / $467.74
| Professional | | $33.88 | $85.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $35.48 / $186.21
| Professional | 26 | $14.45 | $35.48 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $52.48 / $309.03
| Professional | TC | $19.05 | $52.48 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $112.20
| Professional | | $33.88 | $41.69 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $31.62 / $125.89
| Professional | 26 | $15.85 | $31.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $26.30 / $69.18
| Professional | TC | $21.38 | $26.30 | $69.18 |