- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $107.15
| Professional | | $47.86 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $61.66
| Professional | 26 | $28.18 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $44.67
| Professional | TC | $19.05 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $120.23
| Professional | | $66.07 | $83.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $46.77 / $69.18
| Professional | 26 | $36.31 | $46.77 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $52.48
| Professional | TC | $28.18 | $35.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $87.10 / $144.54
| Professional | | $45.71 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $50.12 / $83.18
| Professional | 26 | $28.84 | $50.12 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $36.31 / $63.10
| Professional | TC | $14.13 | $36.31 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $123.03
| Professional | | $47.86 | $77.62 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $69.18
| Professional | 26 | $33.88 | $44.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $53.70
| Professional | TC | $22.91 | $34.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $70.79 / $147.91
| Professional | | $53.70 | $70.79 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $87.10
| Professional | 26 | $30.90 | $42.66 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $58.88
| Professional | TC | $21.88 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $123.03
| Professional | | $54.95 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $44.67 / $69.18
| Professional | 26 | $33.11 | $44.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $53.70
| Professional | TC | $21.88 | $34.67 | $53.70 |