- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $45.71
| Professional | | $25.12 | $34.67 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $48.98 / $107.15
| Professional | 26 | $18.20 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.62 / $7.24 / $13.18
| Professional | TC | $5.62 | $7.24 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $54.95
| Professional | | $19.05 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $44.67
| Professional | | $27.54 | $33.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $34.67
| Professional | 26 | $20.89 | $26.30 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.46 / $7.76 / $10.23
| Professional | TC | $6.46 | $7.76 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $79.43
| Professional | | $28.18 | $40.74 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $34.67
| Professional | 26 | $21.38 | $28.18 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.76 / $8.13 / $10.23
| Professional | TC | $6.76 | $8.13 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $18.20 / $57.54
| Professional | | $16.60 | $18.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.88 / $13.80 / $43.65
| Professional | 26 | $12.88 | $13.80 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.89 / $4.37 / $13.80
| Professional | TC | $3.89 | $4.37 | $13.80 |