- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $102.33
| Professional | | $26.92 | $42.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $36.31
| Professional | 26 | $12.88 | $15.14 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $30.20 / $60.26
| Professional | TC | $12.02 | $30.20 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $169.82
| Professional | | $45.71 | $58.88 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $102.33
| Professional | | $31.62 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $26.92 / $35.48
| Professional | 26 | $17.78 | $26.92 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.80 / $22.91 / $66.07
| Professional | TC | $13.80 | $22.91 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $58.88 / $169.82
| Professional | | $38.02 | $58.88 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $21.38 / $52.48
| Professional | 26 | $19.05 | $21.38 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $39.81 / $51.29
| Professional | TC | $16.60 | $39.81 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $52.48 / $97.72
| Professional | | $38.02 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $21.88 / $35.48
| Professional | 26 | $14.13 | $21.88 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $67.61
| Professional | TC | $16.98 | $32.36 | $67.61 |