- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $346.74 / $1,096.48
| Professional | | $67.61 | $346.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $263.03 / $851.14
| Professional | 26 | $29.51 | $263.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $91.20 / $660.69
| Professional | TC | $40.74 | $91.20 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $89.13 / $97.72
| Professional | | $52.48 | $89.13 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $26.30
| Professional | 26 | $23.44 | $23.44 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $72.44
| Professional | TC | $64.57 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $53.70 / $354.81
| Professional | | $37.15 | $53.70 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $11.48 / $15.49 / $107.15
| Professional | 26 | $11.48 | $15.49 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $251.19
| Professional | TC | $26.30 | $38.02 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $213.80 / $213.80
| Professional | | $125.89 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $60.26 / $60.26
| Professional | 26 | $33.88 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $91.20 / $154.88 / $154.88
| Professional | TC | $91.20 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $398.11
| Professional | | $60.26 | $95.50 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $48.98 / $114.82
| Professional | 26 | $19.05 | $48.98 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $95.50 / $169.82
| Professional | TC | $38.90 | $95.50 | $169.82 |