- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $23.99 / $36.31
| Professional | | $18.20 | $23.99 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $48.98 / $102.33
| Professional | 26 | $15.14 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $5.62 / $7.94
| Professional | TC | $3.98 | $5.62 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $33.88 / $54.95
| Professional | | $14.13 | $33.88 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $25.12 / $40.74
| Professional | 26 | $10.72 | $25.12 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.16 / $7.76 / $15.14
| Professional | TC | $3.16 | $7.76 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $35.48 / $42.66
| Professional | | $30.20 | $35.48 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.39 / $25.12 / $32.36
| Professional | 26 | $22.39 | $25.12 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.59 / $10.00 / $10.47
| Professional | TC | $7.59 | $10.00 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $44.67 / $52.48
| Professional | | $30.20 | $44.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $37.15
| Professional | 26 | $20.89 | $32.36 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $8.91 / $12.59 / $14.79
| Professional | TC | $8.91 | $12.59 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $25.70 / $52.48
| Professional | | $8.13 | $25.70 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $18.62 / $43.65
| Professional | | $17.38 | $18.62 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $14.45 / $33.11
| Professional | 26 | $12.59 | $14.45 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $5.01 / $12.02
| Professional | TC | $4.37 | $5.01 | $12.02 |