- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $263.03
| Professional | | $47.86 | $67.61 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $25.12 / $97.72
| Professional | 26 | $16.98 | $25.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $173.78
| Professional | TC | $31.62 | $48.98 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $70.79
| Professional | 26 | $69.18 | $69.18 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $100.00 / $134.90
| Professional | | $28.18 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.55 / $35.48 / $47.86
| Professional | 26 | $9.55 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.95 / $64.57 / $85.11
| Professional | TC | $19.95 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $70.79 / $194.98
| Professional | | $33.88 | $70.79 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.22 / $21.88 / $60.26
| Professional | 26 | $11.22 | $21.88 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $44.67 / $131.83
| Professional | TC | $19.50 | $44.67 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $95.50 / $213.80
| Professional | | $75.86 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $63.10
| Professional | 26 | $24.55 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $147.91
| Professional | TC | $54.95 | $85.11 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $91.20 / $194.98
| Professional | | $63.10 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $100.00
| Professional | 26 | $22.91 | $34.67 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $39.81 / $63.10 / $144.54
| Professional | TC | $39.81 | $63.10 | $144.54 |