- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $218.78 / $794.33
| Professional | | $91.20 | $218.78 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $79.43 / $354.81
| Professional | 26 | $28.18 | $79.43 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $263.03
| Professional | TC | $58.88 | $107.15 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $158.49 / $371.54
| Professional | | $70.79 | $158.49 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $45.71 / $100.00
| Professional | 26 | $16.60 | $45.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $309.03
| Professional | TC | $54.95 | $87.10 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $354.81
| Professional | | $70.79 | $131.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $74.13
| Professional | 26 | $19.95 | $40.74 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $100.00 / $275.42
| Professional | TC | $47.86 | $100.00 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $269.15 / $380.19
| Professional | | $177.83 | $269.15 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $67.61
| Professional | 26 | $38.02 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $213.80 / $245.47
| Professional | TC | $147.91 | $213.80 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $257.04 / $371.54
| Professional | | $79.43 | $257.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $186.21 / $489.78
| Professional | | $112.20 | $186.21 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $109.65
| Professional | 26 | $26.92 | $40.74 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $398.11
| Professional | TC | $85.11 | $147.91 | $398.11 |