- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $60.26 / $112.20
| Professional | | $46.77 | $60.26 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $44.67
| Professional | 26 | $14.13 | $19.95 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $67.61
| Professional | TC | $30.90 | $39.81 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $67.61
| Professional | | $32.36 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $23.99
| Professional | 26 | $11.48 | $11.48 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $42.66
| Professional | TC | $20.42 | $20.42 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $63.10 / $77.62
| Professional | | $22.91 | $63.10 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $24.55 / $28.84
| Professional | 26 | $22.39 | $24.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $47.86 / $53.70
| Professional | TC | $41.69 | $47.86 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $120.23
| Professional | | $28.84 | $40.74 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $44.67
| Professional | 26 | $10.47 | $14.13 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $26.92 / $77.62
| Professional | TC | $18.62 | $26.92 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $91.20
| Professional | | $63.10 | $79.43 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $33.11
| Professional | 26 | $23.44 | $28.18 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $50.12 / $58.88
| Professional | TC | $38.90 | $50.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $74.13 / $138.04
| Professional | | $30.90 | $74.13 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $56.23
| Professional | 26 | $23.99 | $31.62 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $102.33
| Professional | TC | $44.67 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $74.13 / $128.82
| Professional | | $44.67 | $74.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $27.54 / $45.71
| Professional | 26 | $14.79 | $27.54 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $87.10
| Professional | TC | $28.18 | $46.77 | $87.10 |