- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $107.15 / $181.97
| Professional | | $39.81 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $45.71 / $64.57
| Professional | 26 | $21.38 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $50.12 / $87.10
| Professional | TC | $25.70 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $107.15
| Professional | | $33.88 | $33.88 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $138.04
| Professional | | $107.15 | $107.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $38.02
| Professional | 26 | $33.88 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $100.00
| Professional | TC | $74.13 | $74.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $131.83
| Facility | | $104.71 | $117.49 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $117.49 / $131.83
| Professional | | $104.71 | $117.49 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $158.49
| Facility | | $95.50 | $95.50 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $162.18
| Professional | | $61.66 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $50.12
| Professional | 26 | $20.89 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $112.20
| Professional | TC | $39.81 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $43.65 / $109.65
| Professional | | $38.02 | $43.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $38.02
| Professional | 26 | $14.13 | $14.13 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $67.61
| Professional | TC | $23.99 | $29.51 | $67.61 |