- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $77.62
| Professional | | $19.05 | $25.70 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $47.86 / $120.23
| Professional | 26 | $15.14 | $47.86 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $6.03 / $17.78
| Professional | TC | $3.98 | $6.03 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $28.18
| Professional | | $13.80 | $13.80 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $38.02 / $70.79
| Professional | 26 | $9.77 | $38.02 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $28.18 / $54.95
| Professional | | $12.59 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.33 / $20.89 / $41.69
| Professional | 26 | $9.33 | $20.89 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.16 / $6.03 / $12.88
| Professional | TC | $3.16 | $6.03 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $23.99 / $37.15
| Professional | | $9.12 | $23.99 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $27.54 / $75.86
| Professional | | $14.13 | $27.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $51.29
| Professional | 26 | $10.47 | $15.14 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.24 / $4.27 / $20.42
| Professional | TC | $3.24 | $4.27 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $123.03
| Professional | | $26.30 | $44.67 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $95.50
| Professional | 26 | $18.62 | $30.90 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $13.18 / $28.84
| Professional | TC | $7.94 | $13.18 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $28.18 / $53.70
| Professional | | $8.71 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $67.61
| Professional | | $17.38 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $22.91 / $53.70
| Professional | 26 | $13.49 | $22.91 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.07 / $7.24 / $19.05
| Professional | TC | $4.07 | $7.24 | $19.05 |