- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $60.26 / $77.62
| Professional | | $44.67 | $60.26 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $47.86
| Professional | 26 | $25.70 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.20 / $24.55 / $30.90
| Professional | TC | $18.20 | $24.55 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $75.86
| Professional | | $56.23 | $64.57 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $45.71
| Professional | 26 | $33.11 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $29.51
| Professional | TC | $22.91 | $25.70 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Professional | 26 | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $107.15
| Professional | | $50.12 | $60.26 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $64.57
| Professional | 26 | $29.51 | $35.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $41.69
| Professional | TC | $19.50 | $23.99 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $54.95 / $77.62
| Professional | | $38.90 | $54.95 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $46.77
| Professional | 26 | $22.91 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $21.38 / $30.90
| Professional | TC | $14.79 | $21.38 | $30.90 |