- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $25.12 / $47.86
| Professional | | $18.20 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $33.11 / $144.54
| Professional | 26 | $12.88 | $33.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $6.03 / $10.96
| Professional | TC | $3.98 | $6.03 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $32.36 / $38.02
| Professional | | $31.62 | $32.36 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $28.84
| Professional | 26 | $24.55 | $24.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.59 / $7.76 / $9.12
| Professional | TC | $7.59 | $7.76 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $14.79 / $48.98
| Professional | | $13.18 | $14.79 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $11.22 / $38.02
| Professional | 26 | $8.32 | $11.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.31 / $3.63 / $10.96
| Professional | TC | $3.31 | $3.63 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $24.55 / $33.11
| Professional | | $16.98 | $24.55 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $19.05 / $25.70
| Professional | 26 | $13.18 | $19.05 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $5.13 / $7.94
| Professional | TC | $3.98 | $5.13 | $7.94 |