- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $107.15 / $204.17
| Professional | | $57.54 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $128.82
| Professional | 26 | $19.95 | $26.92 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $57.54 / $83.18 / $120.23
| Professional | TC | $57.54 | $83.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $131.83
| Professional | | $54.95 | $67.61 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $12.59 / $77.62
| Professional | 26 | $12.30 | $12.59 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $52.48
| Professional | TC | $41.69 | $42.66 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $67.61
| Professional | | $39.81 | $39.81 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $13.18 / $29.51
| Professional | 26 | $11.22 | $13.18 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $51.29
| Professional | TC | $28.18 | $28.18 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $79.43 / $147.91
| Facility | | $74.13 | $79.43 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $18.62 / $34.67
| Facility | 26 | $17.78 | $18.62 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $60.26 / $112.20
| Facility | TC | $56.23 | $60.26 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $56.23 / $186.21
| Professional | | $48.98 | $56.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $13.18 / $42.66
| Professional | 26 | $12.30 | $13.18 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $42.66 / $144.54
| Professional | TC | $35.48 | $42.66 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $141.25 / $177.83
| Professional | | $22.91 | $141.25 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $32.36 / $40.74
| Professional | 26 | $6.03 | $32.36 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $109.65 / $138.04
| Professional | TC | $16.98 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $109.65 / $186.21
| Professional | | $102.33 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $25.12 / $44.67
| Professional | 26 | $24.55 | $25.12 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $77.62 / $85.11 / $141.25
| Professional | TC | $77.62 | $85.11 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $35.48 / $77.62
| Facility | | $14.13 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $64.57 / $251.19
| Professional | | $29.51 | $64.57 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $16.60 / $70.79
| Professional | 26 | $15.49 | $16.60 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $47.86 / $177.83
| Professional | TC | $39.81 | $47.86 | $177.83 |