- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $446.68
| Professional | | $74.13 | $100.00 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $512.86
| Professional | 26 | $52.48 | $93.33 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $77.62
| Professional | TC | $28.84 | $38.02 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $91.20
| Professional | | $45.71 | $45.71 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $64.57 / $95.50
| Professional | 26 | $28.18 | $64.57 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $102.33 / $199.53
| Professional | | $45.71 | $102.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $61.66 / $120.23
| Professional | 26 | $29.51 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.45 / $35.48 / $79.43
| Professional | TC | $14.45 | $35.48 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $144.54
| Facility | | $87.10 | $123.03 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $131.83 / $645.65
| Professional | | $60.26 | $131.83 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $89.13 / $380.19
| Professional | 26 | $38.90 | $89.13 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $45.71 / $346.74
| Professional | TC | $20.89 | $45.71 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $38.02 / $63.10
| Facility | | $25.70 | $38.02 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $97.72 / $141.25
| Professional | | $60.26 | $97.72 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $64.57 / $91.20
| Professional | 26 | $38.90 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $48.98
| Professional | TC | $20.89 | $33.88 | $48.98 |