- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $47.86 / $112.20
| Professional | | $27.54 | $47.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $14.79 / $40.74
| Professional | 26 | $7.94 | $14.79 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $97.72
| Professional | TC | $19.05 | $30.90 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $48.98 / $48.98
| Professional | | $13.80 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $16.98
| Facility | 26 | $13.80 | $13.80 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $45.71 / $74.13
| Professional | | $25.12 | $45.71 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $13.80 / $20.42
| Professional | 26 | $7.41 | $13.80 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $31.62 / $53.70
| Professional | TC | $16.60 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $53.70 / $81.28
| Professional | | $46.77 | $53.70 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $16.98
| Facility | 26 | $13.80 | $13.80 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $69.18 / $85.11
| Professional | | $40.74 | $69.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $13.80 / $19.95
| Professional | 26 | $8.51 | $13.80 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $52.48
| Professional | TC | $21.88 | $33.11 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $30.90 / $60.26
| Professional | | $26.92 | $30.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $9.33 / $70.79
| Professional | 26 | $8.51 | $9.33 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $38.02
| Professional | TC | $18.20 | $21.88 | $38.02 |