- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $51.29 / $131.83
| Professional | | $37.15 | $51.29 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $42.66 / $141.25
| Professional | 26 | $25.12 | $42.66 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $16.22 / $45.71
| Professional | TC | $12.02 | $16.22 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $165.96
| Professional | 26 | $16.98 | $34.67 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $51.29 / $112.20
| Professional | | $23.99 | $51.29 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $37.15 / $77.62
| Professional | 26 | $16.22 | $37.15 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $16.22 / $37.15
| Professional | TC | $9.33 | $16.22 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $165.96
| Professional | | $25.70 | $50.12 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $20.42 / $97.72
| Professional | 26 | $17.38 | $20.42 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $53.70
| Professional | TC | $7.76 | $10.96 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $72.44 / $218.78
| Professional | | $48.98 | $72.44 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $53.70 / $154.88
| Professional | 26 | $31.62 | $53.70 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $28.84 / $63.10
| Professional | TC | $16.98 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $51.29 / $100.00
| Professional | | $19.05 | $51.29 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $56.23 / $123.03
| Professional | | $33.11 | $56.23 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.90 / $85.11
| Professional | 26 | $22.91 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $17.78 / $41.69
| Professional | TC | $10.23 | $17.78 | $41.69 |