- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $128.82
| Professional | | $44.67 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.89 / $48.98
| Professional | 26 | $15.85 | $20.89 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $89.13
| Professional | TC | $28.84 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $60.26 / $117.49
| Professional | | $22.39 | $60.26 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $26.92 / $51.29
| Professional | 26 | $9.77 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.59 / $27.54 / $77.62
| Professional | TC | $12.59 | $27.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $79.43 / $131.83
| Professional | | $72.44 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $46.77
| Professional | 26 | $22.91 | $30.90 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $51.29 / $91.20
| Professional | TC | $39.81 | $51.29 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $141.25
| Professional | | $28.84 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $72.44
| Professional | 26 | $12.02 | $15.85 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $64.57
| Professional | TC | $15.14 | $26.92 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | 26 | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $83.18 / $457.09
| Professional | | $43.65 | $83.18 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $36.31 / $158.49
| Professional | 26 | $16.22 | $36.31 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $302.00
| Professional | TC | $25.70 | $50.12 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $70.79 / $138.04
| Professional | | $43.65 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $26.92 / $53.70
| Professional | 26 | $16.22 | $26.92 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $97.72
| Professional | TC | $27.54 | $43.65 | $97.72 |