- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $147.91 / $177.83
| Professional | | $74.13 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $29.51 / $138.04
| Professional | 26 | $15.14 | $29.51 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $125.89 / $162.18
| Professional | TC | $58.88 | $125.89 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $281.84 / $363.08
| Professional | | $64.57 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $33.11 / $43.65
| Professional | 26 | $8.71 | $33.11 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $181.97 / $323.59
| Professional | TC | $44.67 | $181.97 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $208.93 / $288.40
| Professional | | $117.49 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $22.39 / $79.43
| Professional | 26 | $15.49 | $22.39 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $208.93
| Professional | TC | $102.33 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $288.40 / $524.81
| Professional | | $234.42 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $61.66
| Professional | 26 | $27.54 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $251.19 / $467.74
| Professional | TC | $204.17 | $251.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $162.18 / $331.13
| Professional | | $74.13 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $30.20 / $97.72
| Professional | 26 | $15.14 | $30.20 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $234.42
| Professional | TC | $58.88 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $269.15 / $524.81
| Professional | | $120.23 | $269.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $61.66
| Professional | 26 | $20.89 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $213.80 / $467.74
| Professional | TC | $107.15 | $213.80 | $467.74 |