- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $93.33 / $812.83
| Professional | | $42.66 | $93.33 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $44.67 / $93.33
| Professional | 26 | $7.08 | $44.67 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $66.07 / $263.03
| Professional | TC | $36.31 | $66.07 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $125.89 / $154.88
| Professional | | $28.84 | $125.89 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $19.05 / $22.91
| Professional | 26 | $5.01 | $19.05 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $102.33 / $131.83
| Professional | TC | $23.99 | $102.33 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $66.07 / $131.83
| Professional | | $19.50 | $66.07 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $11.75 / $21.38
| Professional | 26 | $7.59 | $11.75 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $69.18 / $109.65
| Professional | TC | $41.69 | $69.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $123.03 / $229.09
| Professional | | $100.00 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $17.38 / $32.36
| Professional | 26 | $14.13 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $194.98
| Professional | TC | $85.11 | $104.71 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $93.33 / $181.97
| Professional | | $43.65 | $93.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $15.14 / $28.18
| Professional | 26 | $7.59 | $15.14 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $81.28 / $154.88
| Professional | TC | $38.02 | $81.28 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $229.09
| Professional | | $66.07 | $114.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $17.38 / $31.62
| Professional | 26 | $10.23 | $17.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $194.98
| Professional | TC | $54.95 | $91.20 | $194.98 |