- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $45.71 / $162.18
| Professional | | $28.84 | $45.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $89.13
| Professional | 26 | $16.98 | $23.99 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.88 / $16.98 / $97.72
| Professional | TC | $12.88 | $16.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $45.71
| Professional | | $37.15 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $44.67 / $181.97
| Professional | | $37.15 | $44.67 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $97.72
| Professional | 26 | $20.42 | $23.99 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $19.95 / $81.28
| Professional | TC | $16.98 | $19.95 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.13 / $23.99 / $33.88
| Facility | 26 | $5.13 | $23.99 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $61.66 / $154.88
| Professional | | $35.48 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $30.90 / $57.54
| Professional | 26 | $19.50 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $107.15
| Professional | TC | $15.14 | $26.92 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $199.53 / $199.53
| Facility | 26 | $48.98 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $97.72 / $758.58
| Professional | | $36.31 | $97.72 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $380.19
| Professional | 26 | $20.89 | $33.11 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.49 / $67.61 / $588.84
| Professional | TC | $15.49 | $67.61 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $144.54
| Professional | | $33.88 | $51.29 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $46.77
| Professional | 26 | $19.50 | $28.18 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $22.39 / $104.71
| Professional | TC | $14.45 | $22.39 | $104.71 |