- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $128.82
| Professional | | $48.98 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $66.07
| Professional | 26 | $18.20 | $24.55 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $37.15 / $83.18
| Professional | TC | $30.20 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $63.10 / $107.15
| Professional | | $31.62 | $63.10 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $26.92 / $43.65
| Professional | 26 | $12.59 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $64.57
| Professional | TC | $18.62 | $35.48 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $12.59 / $23.44
| Facility | 26 | $11.75 | $12.59 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $112.20
| Professional | | $30.20 | $44.67 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $18.20 / $48.98
| Professional | 26 | $11.75 | $18.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $70.79
| Professional | TC | $17.78 | $25.70 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | 26 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $707.95 / $707.95
| Professional | | $467.74 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $199.53 / $199.53
| Professional | 26 | $194.98 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $501.19 / $501.19
| Professional | TC | $309.03 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $52.48 / $97.72
| Professional | | $33.88 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $23.44 / $48.98
| Professional | 26 | $14.13 | $23.44 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $67.61
| Professional | TC | $19.05 | $28.84 | $67.61 |