- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $37.15 / $100.00
| Professional | | $26.92 | $37.15 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $20.89
| Professional | 26 | $6.03 | $8.91 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $28.18 / $46.77
| Professional | TC | $20.89 | $28.18 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | 26 | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $169.82
| Professional | | $41.69 | $41.69 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $35.48
| Professional | 26 | $11.48 | $11.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $39.81
| Professional | TC | $32.36 | $32.36 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $123.03
| Professional | | $37.15 | $50.12 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $12.02 / $29.51
| Professional | 26 | $10.72 | $12.02 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $37.15 / $87.10
| Professional | TC | $23.99 | $37.15 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $9.55
| Professional | 26 | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | TC | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $48.98 / $102.33
| Professional | | $38.02 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $11.22 / $20.89
| Professional | 26 | $8.51 | $11.22 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $81.28
| Professional | TC | $28.84 | $38.02 | $81.28 |