- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $66.07 / $87.10
| Professional | | $56.23 | $66.07 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $61.66
| Professional | 26 | $38.02 | $44.67 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $131.83
| Professional | | $97.72 | $125.89 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $91.20
| Professional | 26 | $66.07 | $87.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $120.23
| Professional | | $72.44 | $102.33 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $87.10
| Professional | 26 | $51.29 | $72.44 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $109.65 / $138.04
| Professional | | $63.10 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $75.86 / $95.50
| Professional | 26 | $44.67 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $218.78
| Facility | 26 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $95.50 / $141.25
| Professional | | $64.57 | $95.50 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $97.72
| Professional | 26 | $44.67 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $239.88
| Professional | | $58.88 | $60.26 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $74.13
| Professional | 26 | $41.69 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $125.89
| Professional | | $66.07 | $89.13 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $89.13
| Professional | 26 | $47.86 | $64.57 | $89.13 |