- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $114.82 / $316.23
| Professional | | $81.28 | $114.82 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $112.20 / $251.19
| Professional | 26 | $53.70 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $89.13
| Professional | TC | $19.95 | $33.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $190.55 / $323.59
| Professional | | $54.95 | $190.55 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $125.89 / $208.93
| Professional | 26 | $36.31 | $125.89 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $74.13 / $95.50
| Professional | TC | $22.39 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $107.15 / $239.88
| Professional | | $63.10 | $107.15 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $165.96
| Professional | 26 | $39.81 | $63.10 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $34.67 / $67.61
| Professional | TC | $16.22 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $186.21 / $245.47
| Professional | | $120.23 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $102.33 / $154.88
| Professional | 26 | $87.10 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $53.70
| Professional | TC | $20.42 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $125.89 / $281.84
| Professional | | $74.13 | $125.89 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $213.80
| Professional | 26 | $56.23 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $70.79
| Professional | TC | $26.92 | $32.36 | $70.79 |