- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $134.90 / $371.54
| Professional | | $107.15 | $134.90 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $107.15 / $446.68
| Professional | 26 | $28.84 | $107.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $288.40
| Professional | TC | $81.28 | $107.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $158.49 / $177.83
| Professional | | $32.36 | $158.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $35.48 / $35.48
| Professional | 26 | $31.62 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $141.25
| Professional | TC | $125.89 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $691.83
| Professional | | $64.57 | $102.33 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $144.54
| Professional | 26 | $16.98 | $21.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $43.65 / $81.28 / $549.54
| Professional | TC | $43.65 | $81.28 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $407.38 / $407.38
| Professional | | $229.09 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $83.18 / $83.18
| Professional | 26 | $45.71 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $331.13 / $331.13
| Professional | TC | $186.21 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $134.90 / $446.68
| Professional | | $95.50 | $134.90 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $66.07 / $154.88
| Professional | 26 | $25.70 | $66.07 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $263.03
| Professional | TC | $81.28 | $107.15 | $263.03 |