- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $38.90 / $109.65
| Professional | | $13.80 | $38.90 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $36.31
| Professional | 26 | $7.08 | $13.80 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.88 / $75.86
| Professional | TC | $19.95 | $33.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $45.71 / $45.71
| Professional | | $12.02 | $45.71 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $14.79
| Facility | 26 | $12.02 | $12.02 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $43.65 / $67.61
| Professional | | $24.55 | $43.65 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.46 / $12.02 / $19.95
| Professional | 26 | $6.46 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $30.20 / $50.12
| Professional | TC | $17.78 | $30.20 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $50.12 / $74.13
| Professional | | $44.67 | $50.12 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $14.79
| Facility | 26 | $12.02 | $12.02 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $63.10 / $77.62
| Professional | | $36.31 | $63.10 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.59 / $12.02 / $17.78
| Professional | 26 | $7.59 | $12.02 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $47.86
| Professional | TC | $20.42 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $28.18 / $79.43
| Professional | | $26.30 | $28.18 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.32 / $63.10
| Professional | 26 | $7.94 | $8.32 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $20.42 / $41.69
| Professional | TC | $18.62 | $20.42 | $41.69 |