- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $85.11 / $309.03
| Professional | | $22.39 | $85.11 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $354.81 / $1,000.00
| Professional | 26 | $51.29 | $354.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $112.20
| Professional | TC | $25.70 | $33.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $194.98
| Professional | 26 | $29.51 | $29.51 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $162.18 / $218.78
| Professional | | $39.81 | $162.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $97.72 / $131.83
| Professional | 26 | $26.92 | $97.72 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $13.49 / $66.07 / $89.13
| Professional | TC | $13.49 | $66.07 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $104.71 / $281.84
| Professional | | $50.12 | $104.71 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $61.66 / $165.96
| Professional | 26 | $29.51 | $61.66 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $40.74 / $117.49
| Professional | TC | $20.42 | $40.74 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $173.78 / $302.00
| Professional | | $112.20 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $102.33 / $181.97
| Professional | 26 | $67.61 | $102.33 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $54.95 / $123.03
| Professional | TC | $45.71 | $54.95 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $269.15
| Professional | | $100.00 | $128.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $85.11 / $162.18
| Professional | 26 | $63.10 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $52.48 / $109.65
| Professional | TC | $34.67 | $52.48 | $109.65 |