- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $104.71 / $977.24
| Professional | | $44.67 | $104.71 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $251.19 / $741.31
| Professional | 26 | $21.88 | $251.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $72.44 / $162.18
| Professional | TC | $26.92 | $72.44 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $102.33 / $114.82
| Professional | | $27.54 | $102.33 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $30.20
| Professional | 26 | $22.91 | $26.92 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $77.62 / $97.72
| Professional | TC | $72.44 | $77.62 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.26 / $56.23 / $186.21
| Professional | | $1.26 | $56.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $0.32 / $15.85 / $50.12
| Professional | 26 | $0.32 | $15.85 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $0.95 / $42.66 / $162.18
| Professional | TC | $0.95 | $42.66 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $134.90 / $181.97
| Professional | | $114.82 | $134.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $43.65
| Professional | 26 | $28.18 | $33.88 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $102.33 / $141.25
| Professional | TC | $85.11 | $102.33 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $72.44 / $141.25
| Professional | | $50.12 | $72.44 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $56.23
| Professional | 26 | $18.20 | $23.99 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $51.29 / $95.50
| Professional | TC | $31.62 | $51.29 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $162.18 / $190.55
| Professional | | $67.61 | $162.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $43.65
| Professional | 26 | $25.12 | $38.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $120.23 / $147.91
| Professional | TC | $42.66 | $120.23 | $147.91 |