- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $190.55 / $794.33
| Professional | | $70.79 | $190.55 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $61.66 / $870.96
| Professional | 26 | $18.20 | $61.66 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $162.18
| Professional | TC | $52.48 | $83.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $66.07
| Professional | 26 | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $173.78 / $173.78
| Professional | | $117.49 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $44.67
| Professional | 26 | $29.51 | $43.65 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $87.10 / $128.82 / $128.82
| Professional | TC | $87.10 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $194.98 / $263.03
| Professional | | $104.71 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $64.57
| Professional | 26 | $40.74 | $52.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $63.10 / $144.54 / $199.53
| Professional | TC | $63.10 | $144.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $109.65 / $758.58
| Professional | | $66.07 | $109.65 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $181.97
| Professional | 26 | $27.54 | $30.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $64.57 / $575.44
| Professional | TC | $34.67 | $64.57 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $190.55 / $269.15
| Professional | | $134.90 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $52.48 / $70.79
| Professional | 26 | $48.98 | $52.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $144.54 / $199.53
| Professional | TC | $81.28 | $144.54 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $269.15
| Professional | | $245.47 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $64.57 / $70.79
| Professional | 26 | $63.10 | $64.57 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $199.53
| Professional | TC | $181.97 | $181.97 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $102.33 / $199.53
| Professional | | $66.07 | $102.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $29.51 / $70.79
| Professional | 26 | $26.30 | $29.51 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $77.62 / $117.49
| Professional | TC | $38.90 | $77.62 | $117.49 |