- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $60.26 / $87.10
| Professional | | $47.86 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $37.15 / $66.07
| Professional | 26 | $28.18 | $37.15 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $33.88
| Professional | TC | $19.05 | $23.99 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $83.18
| Professional | | $63.10 | $63.10 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $51.29
| Professional | 26 | $38.90 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $32.36
| Professional | TC | $24.55 | $24.55 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.88 / $57.54
| Professional | | $23.44 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $74.13 / $97.72
| Professional | | $52.48 | $74.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $44.67 / $60.26
| Professional | 26 | $32.36 | $44.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $37.15
| Professional | TC | $20.89 | $28.18 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $61.66
| Professional | 26 | $38.90 | $38.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $60.26 / $87.10
| Professional | | $40.74 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $36.31 / $53.70
| Professional | 26 | $25.70 | $36.31 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $33.88
| Professional | TC | $16.98 | $23.99 | $33.88 |