- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $102.33
| Professional | | $34.67 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $39.81 / $72.44
| Professional | 26 | $22.91 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $22.91 / $30.90
| Professional | TC | $12.02 | $22.91 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $54.95
| Professional | | $27.54 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $39.81
| Professional | 26 | $18.20 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $14.45
| Professional | TC | $9.77 | $9.77 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $239.88
| Professional | | $56.23 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $57.54 / $87.10
| Professional | 26 | $22.91 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $29.51 / $48.98
| Professional | TC | $12.02 | $29.51 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $245.47 / $309.03
| Professional | | $85.11 | $245.47 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $162.18 / $199.53
| Professional | 26 | $51.29 | $162.18 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $83.18 / $107.15
| Professional | TC | $33.88 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $54.95
| Professional | | $27.54 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $39.81
| Professional | 26 | $18.20 | $18.20 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $14.45
| Professional | TC | $9.77 | $9.77 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $85.11 / $223.87
| Professional | | $57.54 | $85.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $162.18
| Professional | 26 | $39.81 | $56.23 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $60.26
| Professional | TC | $18.20 | $29.51 | $60.26 |