- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $66.07 / $173.78
| Professional | | $52.48 | $66.07 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $97.72
| Professional | 26 | $28.18 | $36.31 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $35.48
| Professional | TC | $19.05 | $23.99 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $109.65
| Professional | | $72.44 | $79.43 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $52.48
| Professional | 26 | $34.67 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $38.90
| Professional | TC | $26.30 | $31.62 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $41.69 / $58.88
| Facility | 26 | $8.91 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $77.62 / $162.18
| Professional | | $42.66 | $77.62 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $97.72
| Professional | 26 | $28.84 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $64.57
| Professional | TC | $16.98 | $28.18 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $100.00
| Professional | | $38.02 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $89.13
| Professional | | $30.90 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $56.23
| Professional | 26 | $20.42 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.23 / $21.38 / $34.67
| Professional | TC | $10.23 | $21.38 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Facility | 26 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $524.81
| Professional | | $398.11 | $398.11 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | 26 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $234.42
| Professional | TC | $165.96 | $165.96 | $234.42 |