- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $48.98
| Professional | | $25.12 | $32.36 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $19.95
| Professional | 26 | $10.96 | $15.14 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $33.11
| Professional | TC | $12.02 | $15.85 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $281.84
| Facility | | $229.09 | $229.09 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $22.91 / $32.36
| Professional | | $11.22 | $22.91 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $87.10
| Professional | | $30.90 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $30.20
| Professional | 26 | $13.18 | $19.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $30.20 / $56.23
| Professional | TC | $16.22 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $45.71
| Professional | | $22.39 | $32.36 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $72.44
| Facility | | $26.92 | $46.77 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $87.10
| Professional | | $30.90 | $53.70 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.50 / $30.20
| Professional | 26 | $13.18 | $19.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $30.20 / $56.23
| Professional | TC | $16.22 | $30.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $74.13
| Professional | | $28.84 | $50.12 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $27.54
| Professional | 26 | $14.13 | $20.42 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $30.20 / $47.86
| Professional | TC | $15.14 | $30.20 | $47.86 |