- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $41.69
| Professional | | $25.12 | $28.84 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $19.05
| Professional | 26 | $12.02 | $14.13 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $15.14 / $22.91
| Professional | TC | $12.88 | $15.14 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $77.62 / $85.11
| Professional | | $56.23 | $77.62 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $40.74
| Professional | 26 | $26.92 | $36.31 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $45.71
| Professional | TC | $30.20 | $40.74 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $64.57 / $112.20
| Professional | | $28.84 | $64.57 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $29.51 / $52.48
| Professional | 26 | $13.49 | $29.51 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $33.88 / $60.26
| Professional | TC | $15.49 | $33.88 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $67.61
| Facility | | $25.70 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $54.95 / $354.81
| Professional | | $28.84 | $54.95 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $22.91 / $97.72
| Professional | 26 | $14.13 | $22.91 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $25.12 / $181.97
| Professional | TC | $15.14 | $25.12 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $41.69 / $77.62
| Professional | | $28.84 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.49 / $19.50 / $33.88
| Professional | 26 | $13.49 | $19.50 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $21.88 / $38.90
| Professional | TC | $15.14 | $21.88 | $38.90 |