- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $61.66 / $120.23
| Professional | | $50.12 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $69.18
| Professional | 26 | $20.89 | $25.70 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $52.48
| Professional | TC | $25.70 | $33.11 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $60.26 / $75.86
| Professional | | $56.23 | $60.26 | $75.86 |
- 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
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $112.20
| Professional | | $53.70 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $40.74
| Professional | 26 | $21.88 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $169.82
| Professional | 50 | $81.28 | $109.65 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $69.18
| Professional | TC | $27.54 | $44.67 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $77.62
| Facility | | $25.70 | $40.74 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $74.13
| Professional | | $25.12 | $33.88 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $75.86 / $131.83
| Professional | | $52.48 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $50.12
| Professional | 26 | $21.88 | $29.51 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $43.65 / $66.07
| Professional | TC | $28.18 | $43.65 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $91.20
| Professional | | $51.29 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $35.48
| Professional | 26 | $22.39 | $26.92 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $57.54
| Professional | TC | $28.18 | $37.15 | $57.54 |