- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $177.83
| Professional | | $47.86 | $64.57 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $190.55
| Professional | 26 | $28.18 | $36.31 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $38.02
| Professional | TC | $19.05 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $162.18
| Professional | | $109.65 | $147.91 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $93.33
| Professional | 26 | $61.66 | $85.11 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $70.79
| Professional | TC | $46.77 | $63.10 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $123.03 / $218.78
| Professional | | $56.23 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $70.79 / $123.03
| Professional | 26 | $32.36 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $53.70 / $95.50
| Professional | TC | $24.55 | $53.70 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $104.71 / $398.11
| Professional | | $57.54 | $104.71 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $54.95 / $346.74
| Professional | 26 | $33.11 | $54.95 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $165.96
| Professional | TC | $22.91 | $37.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $141.25
| Professional | | $54.95 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $45.71 / $79.43
| Professional | 26 | $32.36 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $57.54
| Professional | TC | $22.91 | $33.88 | $57.54 |