- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $44.67 / $186.21
| Professional | | $40.74 | $44.67 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $89.13 / $269.15
| Professional | 26 | $25.70 | $89.13 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $16.98 / $87.10
| Professional | TC | $14.13 | $16.98 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Professional | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $87.10 / $117.49
| Professional | | $23.44 | $87.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $56.23 / $75.86
| Professional | 26 | $15.14 | $56.23 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.32 / $30.90 / $41.69
| Professional | TC | $8.32 | $30.90 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $56.23 / $154.88
| Professional | | $27.54 | $56.23 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $35.48 / $93.33
| Professional | 26 | $16.98 | $35.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.96 / $20.42 / $61.66
| Professional | TC | $10.96 | $20.42 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $75.86 / $169.82
| Professional | | $40.74 | $75.86 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $104.71
| Professional | 26 | $39.81 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $67.61
| Professional | TC | $24.55 | $29.51 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $74.13 / $186.21
| Professional | | $54.95 | $74.13 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $54.95 / $114.82
| Professional | 26 | $36.31 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $58.88
| Professional | TC | $19.50 | $28.18 | $58.88 |