- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $114.82 / $190.55
| Professional | | $50.12 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $48.98 / $107.15
| Professional | 26 | $21.88 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $70.79 / $141.25
| Professional | TC | $42.66 | $70.79 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $131.83
| Professional | | $18.20 | $18.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $131.83
| Professional | | $109.65 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $20.42
| Professional | 26 | $18.20 | $18.20 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $112.20
| Professional | TC | $91.20 | $91.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $158.49
| Facility | | $107.15 | $144.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $144.54 / $158.49
| Professional | | $107.15 | $144.54 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $186.21
| Facility | | $112.20 | $112.20 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $114.82 / $190.55
| Professional | | $77.62 | $114.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $18.20 / $26.92
| Professional | 26 | $11.22 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $162.18
| Professional | TC | $66.07 | $97.72 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $46.77 / $131.83
| Professional | | $41.69 | $46.77 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $7.59 / $20.42
| Professional | 26 | $7.59 | $7.59 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $112.20
| Professional | TC | $33.88 | $38.90 | $112.20 |