- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $120.23 / $158.49
| Professional | | $93.33 | $120.23 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $19.05
| Professional | 26 | $12.02 | $14.13 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $104.71 / $128.82
| Professional | TC | $79.43 | $104.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $144.54 / $169.82
| Professional | | $14.79 | $144.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $16.60 / $17.78
| Professional | 26 | $14.79 | $16.60 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $141.25 / $158.49
| Professional | TC | $128.82 | $141.25 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $218.78
| Professional | | $91.20 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $16.98 / $25.12
| Professional | 26 | $12.59 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $194.98
| Professional | TC | $75.86 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $147.91 / $218.78
| Professional | | $123.03 | $147.91 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $16.22 / $25.12
| Professional | 26 | $12.88 | $16.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $109.65 / $134.90 / $194.98
| Professional | TC | $109.65 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $100.00 / $190.55
| Professional | | $70.79 | $100.00 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $13.80 / $25.12
| Professional | 26 | $10.72 | $13.80 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $165.96
| Professional | TC | $60.26 | $87.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $158.49 / $229.09
| Professional | | $83.18 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $16.22 / $23.44
| Professional | 26 | $8.91 | $16.22 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $141.25 / $204.17
| Professional | TC | $74.13 | $141.25 | $204.17 |