- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $186.21 / $549.54
| Professional | | $66.07 | $186.21 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $74.13 / $316.23
| Professional | 26 | $23.99 | $74.13 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $69.18 / $208.93
| Professional | TC | $42.66 | $69.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $151.36 / $263.03
| Professional | | $44.67 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $57.54 / $102.33
| Professional | 26 | $16.22 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $95.50 / $165.96
| Professional | TC | $29.51 | $95.50 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $102.33 / $218.78
| Professional | | $50.12 | $102.33 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $38.90 / $77.62
| Professional | 26 | $18.20 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $48.98 / $147.91
| Professional | TC | $24.55 | $48.98 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $134.90 / $223.87
| Professional | | $70.79 | $134.90 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $72.44 / $117.49
| Professional | 26 | $34.67 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $123.03 / $190.55
| Professional | TC | $19.05 | $123.03 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $128.82 / $257.04
| Professional | | $56.23 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $251.19
| Professional | | $79.43 | $117.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $47.86 / $125.89
| Professional | 26 | $26.92 | $47.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $165.96
| Professional | TC | $50.12 | $79.43 | $165.96 |