- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $123.03
| Professional | | $47.86 | $58.88 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $85.11
| Professional | 26 | $19.95 | $25.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $35.48 / $67.61
| Professional | TC | $28.84 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $120.23
| Professional | | $79.43 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $58.88
| Professional | 26 | $42.66 | $42.66 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | TC | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $42.66 / $109.65
| Professional | | $33.11 | $42.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $16.60 / $75.86
| Professional | 26 | $12.30 | $16.60 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $25.12 / $66.07
| Professional | TC | $10.96 | $25.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $75.86 / $134.90
| Professional | | $56.23 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $60.26
| Professional | 26 | $21.88 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $85.11
| Professional | TC | $33.88 | $44.67 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.02 / $109.65
| Professional | | $33.11 | $38.02 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $15.14 / $39.81
| Professional | 26 | $12.30 | $15.14 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $24.55 / $47.86
| Professional | TC | $10.96 | $24.55 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $63.10 / $93.33
| Professional | | $38.90 | $63.10 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $95.50
| Professional | 26 | $17.38 | $29.51 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $56.23
| Professional | TC | $20.89 | $37.15 | $56.23 |