- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $275.42
| Professional | | $56.23 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $25.70 / $316.23
| Professional | 26 | $15.85 | $25.70 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $288.40
| Professional | | $38.90 | $38.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $22.39 / $67.61
| Professional | 26 | $11.22 | $22.39 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $91.20 / $177.83
| Professional | | $38.02 | $91.20 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $29.51 / $42.66
| Facility | 26 | $6.31 | $29.51 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $138.04 / $426.58
| Professional | | $53.70 | $138.04 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $31.62 / $89.13
| Professional | 26 | $14.45 | $31.62 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $131.83 / $204.17
| Professional | | $85.11 | $131.83 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $151.36
| Professional | 26 | $19.05 | $26.92 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $147.91 / $263.03
| Professional | | $70.79 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $52.48
| Professional | 26 | $21.88 | $36.31 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $50.12 / $177.83
| Professional | 26 | $27.54 | $50.12 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $138.04 / $151.36
| Professional | | $109.65 | $138.04 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $30.90
| Professional | 26 | $25.70 | $25.70 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $117.49 / $234.42
| Professional | | $60.26 | $117.49 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $27.54 / $48.98
| Professional | 26 | $13.80 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $138.04 / $288.40
| Professional | | $70.79 | $138.04 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $56.23
| Professional | 26 | $21.88 | $31.62 | $56.23 |