- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $85.11
| Professional | | $30.90 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $70.79 / $575.44
| Professional | 26 | $22.91 | $70.79 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $19.95 / $33.88
| Professional | TC | $9.77 | $19.95 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $28.18 / $38.90
| Professional | 26 | $14.13 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $81.28 / $87.10
| Professional | | $37.15 | $81.28 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $64.57
| Professional | 26 | $47.86 | $47.86 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $27.54 / $104.71
| Professional | | $20.89 | $27.54 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $17.78 / $112.20
| Professional | 26 | $13.49 | $17.78 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.75 / $11.75 / $33.88
| Professional | TC | $5.75 | $11.75 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $56.23 / $120.23
| Professional | | $38.90 | $56.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $309.03
| Professional | 26 | $25.12 | $38.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $21.88 / $47.86
| Professional | TC | $11.48 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $74.13
| Professional | | $20.89 | $26.30 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $15.85 / $44.67
| Professional | 26 | $13.49 | $15.85 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.75 / $10.96 / $25.70
| Professional | TC | $5.75 | $10.96 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $42.66 / $72.44
| Professional | | $25.70 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $31.62 / $120.23
| Professional | 26 | $18.62 | $31.62 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.92 / $13.80 / $30.20
| Professional | TC | $6.92 | $13.80 | $30.20 |