- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $56.23 / $190.55
| Professional | | $36.31 | $56.23 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.60 / $41.69
| Professional | 26 | $10.00 | $16.60 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $69.18
| Professional | TC | $25.12 | $40.74 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $58.88
| Professional | | $16.22 | $16.22 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $19.95
| Facility | 26 | $16.22 | $16.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $58.88 / $91.20
| Professional | | $33.88 | $58.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.00 / $16.98 / $29.51
| Professional | 26 | $10.00 | $16.98 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $64.57
| Professional | TC | $23.44 | $39.81 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $97.72
| Professional | | $61.66 | $64.57 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $19.95
| Facility | 26 | $16.22 | $16.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $83.18 / $102.33
| Professional | | $51.29 | $83.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $24.55
| Professional | 26 | $10.96 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $40.74 / $63.10
| Professional | TC | $28.18 | $40.74 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $39.81 / $79.43
| Professional | | $37.15 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $12.88 / $85.11
| Professional | 26 | $11.48 | $12.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $28.18 / $57.54
| Professional | TC | $24.55 | $28.18 | $57.54 |