- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $204.17 / $724.44
| Professional | | $64.57 | $204.17 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $70.79 / $354.81
| Professional | 26 | $22.39 | $70.79 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $69.18 / $95.50
| Professional | TC | $44.67 | $69.18 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $104.71 / $239.88
| Professional | | $45.71 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $30.90 / $56.23
| Professional | 26 | $12.59 | $30.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $181.97
| Professional | TC | $32.36 | $72.44 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $63.10
| Professional | | $32.36 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $134.90 / $151.36
| Professional | | $120.23 | $134.90 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $45.71
| Professional | 26 | $27.54 | $30.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $102.33 / $107.15
| Professional | TC | $91.20 | $102.33 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $165.96 / $190.55
| Professional | | $114.82 | $165.96 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $54.95
| Professional | 26 | $25.70 | $38.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $125.89 / $144.54
| Professional | TC | $87.10 | $125.89 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $66.07 / $190.55
| Professional | | $26.30 | $66.07 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $67.61 / $151.36
| Professional | | $58.88 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $16.60 / $41.69
| Professional | 26 | $15.49 | $16.60 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $52.48 / $120.23
| Professional | TC | $42.66 | $52.48 | $120.23 |