- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $74.13 / $77.62
| Professional | | $33.11 | $74.13 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $22.91 / $33.11
| Professional | 26 | $10.23 | $22.91 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $48.98 / $52.48
| Professional | TC | $19.95 | $48.98 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $158.49
| Professional | | $45.71 | $45.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $46.77
| Professional | 26 | $14.13 | $14.13 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $35.48
| Professional | TC | $30.20 | $30.20 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $112.20
| Professional | | $43.65 | $47.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $34.67
| Professional | 26 | $15.14 | $15.85 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $64.57
| Professional | TC | $28.18 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $11.75
| Professional | 26 | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | TC | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $47.86 / $93.33
| Professional | | $36.31 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $16.60 / $28.84
| Professional | 26 | $12.02 | $16.60 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $32.36 / $66.07
| Professional | TC | $24.55 | $32.36 | $66.07 |