- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $114.82
| Professional | | $44.67 | $66.07 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $81.28
| Professional | 26 | $19.05 | $26.92 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $60.26
| Professional | TC | $25.70 | $34.67 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $83.18 / $134.90
| Professional | | $50.12 | $83.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $41.69
| Professional | 26 | $20.42 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $75.86 / $123.03 / $199.53
| Professional | 50 | $75.86 | $123.03 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $50.12 / $93.33
| Professional | TC | $29.51 | $50.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $91.20 / $158.49
| Professional | | $54.95 | $91.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $67.61
| Professional | 26 | $20.42 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $58.88 / $93.33
| Professional | TC | $30.90 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $107.15
| Professional | | $44.67 | $56.23 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $34.67 / $42.66
| Professional | 26 | $30.90 | $34.67 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $61.66 / $64.57
| Professional | TC | $44.67 | $61.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $134.90
| Professional | | $61.66 | $61.66 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $117.49
| Professional | | $44.67 | $63.10 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $48.98
| Professional | 26 | $18.20 | $26.30 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $69.18
| Professional | TC | $27.54 | $38.02 | $69.18 |