- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $87.10
| Professional | | $19.05 | $28.84 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $17.38 / $45.71
| Professional | 26 | $5.01 | $17.38 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $21.38 / $63.10
| Professional | TC | $14.13 | $21.38 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $30.90 / $38.02
| Professional | | $5.75 | $30.90 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $6.46 / $7.76
| Professional | 26 | $5.75 | $6.46 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $27.54 / $27.54
| Professional | TC | $24.55 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $19.05 / $138.04
| Professional | | $14.45 | $19.05 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $4.17 / $47.86
| Professional | 26 | $3.09 | $4.17 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.48 / $15.85 / $112.20
| Professional | TC | $11.48 | $15.85 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $79.43 / $79.43
| Professional | | $43.65 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $14.79 / $14.79
| Professional | 26 | $8.32 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $64.57 / $64.57
| Professional | TC | $35.48 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $60.26 / $95.50
| Professional | | $20.42 | $60.26 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.79 / $14.79 / $95.50
| Professional | 26 | $4.79 | $14.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $47.86 / $95.50
| Professional | TC | $15.49 | $47.86 | $95.50 |