- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $46.77 / $147.91
| Professional | | $34.67 | $46.77 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $41.69 / $138.04
| Professional | 26 | $23.99 | $41.69 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $51.29
| Professional | TC | $12.02 | $16.98 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $87.10 / $134.90
| Professional | | $23.99 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $56.23 / $93.33
| Professional | 26 | $16.22 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $9.33 / $32.36 / $45.71
| Professional | TC | $9.33 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $45.71 / $112.20
| Professional | | $25.70 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $72.44
| Professional | 26 | $17.78 | $28.84 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $16.60 / $39.81
| Professional | TC | $7.94 | $16.60 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $93.33 / $165.96
| Professional | | $57.54 | $93.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $37.15 / $57.54 / $100.00
| Professional | 26 | $37.15 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.38 / $29.51 / $44.67
| Professional | TC | $17.38 | $29.51 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $141.25
| Professional | | $41.69 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $95.50
| Professional | 26 | $26.30 | $39.81 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $54.95
| Professional | TC | $12.88 | $21.38 | $54.95 |