- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $83.18 / $162.18
| Professional | | $63.10 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $208.93
| Professional | 26 | $45.71 | $70.79 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $51.29
| Professional | TC | $21.88 | $30.20 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | 26 | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $134.90
| Professional | | $85.11 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 26 | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $75.86 / $138.04
| Professional | | $33.11 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $79.43 / $151.36
| Professional | | $41.69 | $79.43 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $147.91
| Professional | 26 | $26.92 | $36.31 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $22.91 / $52.48
| Professional | TC | $12.30 | $22.91 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $114.82 / $218.78
| Professional | | $75.86 | $114.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $169.82
| Professional | 26 | $51.29 | $77.62 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $75.86
| Professional | TC | $26.92 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $61.66 / $123.03
| Professional | | $41.69 | $61.66 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $83.18
| Professional | 26 | $26.92 | $32.36 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $19.05 / $42.66
| Professional | TC | $12.30 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $162.18
| Professional | | $54.95 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $64.57 / $131.83
| Professional | 26 | $38.02 | $64.57 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $26.92 / $44.67
| Professional | TC | $16.60 | $26.92 | $44.67 |