- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $154.88
| Professional | | $61.66 | $72.44 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $229.09
| Professional | 26 | $43.65 | $56.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $23.99 / $48.98
| Professional | TC | $20.89 | $23.99 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $77.62
| Professional | 26 | $28.18 | $28.18 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $100.00 / $194.98
| Professional | | $83.18 | $100.00 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $138.04
| Professional | 26 | $57.54 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $53.70
| Professional | TC | $22.91 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $67.61 / $169.82
| Professional | | $64.57 | $67.61 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $45.71 / $112.20
| Professional | 26 | $43.65 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.38 / $22.39 / $56.23
| Professional | TC | $21.38 | $22.39 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $67.61 / $134.90
| Professional | | $27.54 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $177.83
| Professional | | $41.69 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $56.23 / $112.20
| Professional | 26 | $28.18 | $56.23 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $27.54 / $54.95
| Professional | TC | $12.30 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $83.18 / $144.54
| Professional | | $41.69 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $64.57 / $154.88
| Professional | 26 | $28.18 | $64.57 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $26.30 / $47.86
| Professional | TC | $12.30 | $26.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $144.54
| Professional | | $89.13 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $75.86 / $95.50
| Professional | 26 | $58.88 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $38.02 / $52.48
| Professional | TC | $29.51 | $38.02 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $165.96
| Professional | | $52.48 | $87.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $63.10 / $123.03
| Professional | 26 | $35.48 | $63.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $24.55 / $47.86
| Professional | TC | $14.79 | $24.55 | $47.86 |