- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $48.98 / $123.03
| Professional | | $46.77 | $48.98 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $18.20 / $47.86
| Professional | 26 | $12.02 | $18.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $75.86
| Professional | TC | $30.90 | $33.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $125.89 / $131.83
| Professional | | $112.20 | $125.89 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $48.98 / $51.29
| Professional | 26 | $42.66 | $48.98 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $75.86 / $81.28
| Professional | TC | $69.18 | $75.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $56.23
| Professional | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $21.38
| Professional | 26 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | TC | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $112.20 / $117.49
| Professional | | $104.71 | $112.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $41.69 / $43.65
| Professional | 26 | $38.90 | $41.69 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $74.13
| Professional | TC | $66.07 | $66.07 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $120.23 / $125.89
| Professional | | $114.82 | $120.23 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $44.67
| Professional | 26 | $42.66 | $42.66 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $70.79 / $75.86 / $79.43
| Professional | TC | $70.79 | $75.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $165.96
| Professional | | $58.88 | $60.26 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $23.44 / $63.10
| Professional | 26 | $22.91 | $23.44 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $104.71
| Professional | TC | $36.31 | $36.31 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $44.67 / $75.86
| Professional | | $34.67 | $44.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.60 / $27.54
| Professional | 26 | $12.02 | $16.60 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $46.77
| Professional | TC | $22.39 | $28.18 | $46.77 |