- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $52.48 / $61.66
| Professional | | $46.77 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $8.91 / $10.00
| Professional | 26 | $7.08 | $8.91 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $43.65 / $51.29
| Professional | TC | $38.90 | $43.65 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $63.10 / $104.71
| Professional | | $46.77 | $63.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $7.41 / $18.20
| Professional | 26 | $6.92 | $7.41 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $37.15 / $39.81 / $52.48
| Professional | TC | $37.15 | $39.81 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $50.12 / $120.23
| Professional | | $34.67 | $50.12 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $8.32 / $17.78
| Professional | 26 | $6.31 | $8.32 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $91.20
| Professional | TC | $26.30 | $41.69 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $47.86 / $89.13
| Professional | | $28.84 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.51 / $14.13
| Professional | 26 | $6.03 | $8.51 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $40.74 / $74.13
| Professional | TC | $24.55 | $40.74 | $74.13 |