- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $147.91
| Professional | | $34.67 | $47.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $77.62 / $229.09
| Professional | 26 | $26.92 | $77.62 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $46.77
| Professional | TC | $12.02 | $16.98 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $50.12
| Professional | | $26.30 | $44.67 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $35.48
| Professional | 26 | $26.30 | $26.30 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $20.42 / $20.42
| Professional | TC | $18.20 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $223.87
| Professional | | $25.70 | $32.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $20.42 / $165.96
| Professional | 26 | $15.49 | $20.42 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.55 / $12.59 / $89.13
| Professional | TC | $9.55 | $12.59 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $128.82 / $128.82
| Professional | | $70.79 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $75.86 / $75.86
| Professional | 26 | $41.69 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $52.48 / $52.48
| Professional | TC | $28.84 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $95.50 / $141.25
| Professional | | $37.15 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $61.66 / $141.25
| Professional | 26 | $24.55 | $61.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $15.49 / $42.66
| Professional | TC | $11.75 | $15.49 | $42.66 |