- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $269.15
| Professional | | $81.28 | $109.65 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $75.86
| Professional | 26 | $25.12 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $70.79 / $173.78
| Professional | TC | $57.54 | $70.79 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $162.18 / $162.18
| Professional | | $114.82 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | 26 | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Professional | TC | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $104.71 / $245.47
| Professional | | $51.29 | $104.71 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $30.90 / $67.61
| Professional | 26 | $14.45 | $30.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $69.18 / $177.83
| Professional | TC | $36.31 | $69.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $257.04 / $363.08
| Professional | | $95.50 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $58.88 / $89.13
| Professional | 26 | $28.18 | $58.88 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $173.78 / $263.03
| Professional | TC | $67.61 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $97.72 / $257.04
| Professional | | $51.29 | $97.72 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $81.28
| Professional | 26 | $14.45 | $26.92 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $173.78
| Professional | TC | $36.31 | $63.10 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $151.36 / $257.04
| Professional | | $69.18 | $151.36 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $39.81 / $70.79
| Professional | 26 | $21.38 | $39.81 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $102.33 / $186.21
| Professional | TC | $47.86 | $102.33 | $186.21 |