- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $54.95
| Professional | | $14.13 | $19.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $24.55 / $79.43
| Professional | 26 | $10.47 | $24.55 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.01 / $8.13 / $21.38
| Professional | TC | $5.01 | $8.13 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $22.39
| Professional | | $9.12 | $9.12 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $5.62 / $13.49
| Professional | 26 | $5.50 | $5.62 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.47 / $4.47 / $5.25
| Professional | TC | $4.47 | $4.47 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $20.89 / $36.31
| Professional | | $10.23 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.17 / $13.18 / $21.88
| Professional | 26 | $6.17 | $13.18 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.98 / $7.59 / $14.45
| Professional | TC | $3.98 | $7.59 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.91 / $16.22
| Facility | | $8.32 | $8.91 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $6.03 / $11.22
| Facility | 26 | $5.62 | $6.03 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.63 / $2.82 / $5.25
| Facility | TC | $2.63 | $2.82 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.80 / $34.67
| Professional | | $9.12 | $13.80 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.62 / $8.91 / $23.44
| Professional | 26 | $5.62 | $8.91 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.55 / $4.57 / $13.18
| Professional | TC | $3.55 | $4.57 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Facility | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | TC | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $169.82 / $169.82
| Professional | | $131.83 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | TC | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $17.78 / $39.81
| Professional | | $11.22 | $17.78 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $11.48 / $28.18
| Professional | 26 | $7.08 | $11.48 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $6.31 / $12.59
| Professional | TC | $4.37 | $6.31 | $12.59 |