- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $81.28 / $234.42
| Professional | | $53.70 | $81.28 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $141.25
| Professional | 26 | $12.59 | $22.39 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $169.82
| Professional | TC | $41.69 | $57.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $60.26 / $83.18
| Professional | | $58.88 | $60.26 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.13 / $14.79 / $20.42
| Professional | 26 | $14.13 | $14.79 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $45.71 / $63.10
| Professional | TC | $43.65 | $45.71 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $77.62 / $107.15
| Professional | | $42.66 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $21.88 / $34.67
| Professional | 26 | $10.47 | $21.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $41.69 / $85.11
| Professional | TC | $23.44 | $41.69 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $93.33 / $630.96
| Professional | | $50.12 | $93.33 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $21.88 / $169.82
| Professional | 26 | $13.18 | $21.88 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $70.79 / $501.19
| Professional | TC | $38.90 | $70.79 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $58.88 / $120.23
| Professional | | $48.98 | $58.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.75 / $13.80 / $28.18
| Professional | 26 | $11.75 | $13.80 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $45.71 / $93.33
| Professional | TC | $38.02 | $45.71 | $93.33 |