- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $61.66 / $117.49
| Professional | | $40.74 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $28.84 / $63.10
| Professional | 26 | $21.88 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $30.90 / $61.66
| Professional | TC | $15.85 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $69.18 / $104.71
| Professional | | $58.88 | $69.18 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $30.90 / $48.98
| Professional | 26 | $26.30 | $30.90 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $67.61 / $79.43
| Professional | | $46.77 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $34.67
| Professional | 26 | $20.89 | $29.51 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $44.67
| Professional | TC | $26.92 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $134.90
| Professional | | $52.48 | $63.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $77.62
| Professional | 26 | $25.70 | $38.02 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $24.55 / $74.13
| Professional | TC | $19.50 | $24.55 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $48.98 / $70.79
| Professional | | $37.15 | $48.98 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $38.90
| Professional | 26 | $19.95 | $26.30 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $23.44 / $33.88
| Professional | TC | $16.98 | $23.44 | $33.88 |