- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $109.65
| Professional | | $37.15 | $57.54 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $44.67
| Professional | 26 | $19.05 | $23.99 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $33.88 / $69.18
| Professional | TC | $15.85 | $33.88 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $56.23 / $208.93
| Professional | | $56.23 | $56.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $128.82
| Professional | | $47.86 | $77.62 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $42.66 / $47.86
| Professional | 26 | $26.92 | $42.66 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $79.43
| Professional | TC | $19.95 | $34.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $74.13 / $208.93
| Professional | | $51.29 | $74.13 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $29.51 / $74.13
| Professional | 26 | $26.92 | $29.51 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $47.86 / $60.26
| Professional | TC | $21.88 | $47.86 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $144.54
| Professional | | $47.86 | $67.61 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $33.88 / $48.98
| Professional | 26 | $19.50 | $33.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $37.15 / $77.62
| Professional | TC | $26.30 | $37.15 | $77.62 |