- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $29.51 / $63.10
| Professional | | $16.98 | $29.51 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $63.10 / $131.83
| Professional | 26 | $12.88 | $63.10 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $6.76 / $14.79
| Professional | TC | $3.98 | $6.76 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $46.77
| Professional | | $33.11 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $50.12
| Professional | | $46.77 | $46.77 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $37.15
| Professional | 26 | $33.11 | $33.11 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $13.18
| Professional | TC | $12.88 | $12.88 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $51.29 / $60.26
| Professional | | $50.12 | $51.29 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $67.61
| Professional | | $26.92 | $45.71 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $47.86
| Professional | 26 | $20.42 | $33.11 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $11.22 / $19.95
| Professional | TC | $6.76 | $11.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.62 / $50.12
| Professional | | $18.20 | $18.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $36.31
| Professional | 26 | $13.80 | $13.80 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $4.47 / $12.30
| Professional | TC | $4.37 | $4.47 | $12.30 |