- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $141.25 / $302.00
| Professional | | $57.54 | $141.25 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $61.66 / $138.04
| Professional | 26 | $23.99 | $61.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $91.20 / $223.87
| Professional | TC | $34.67 | $91.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $177.83 / $295.12
| Professional | | $41.69 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.60 / $58.88 / $104.71
| Professional | 26 | $16.60 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $107.15 / $199.53
| Professional | TC | $25.12 | $107.15 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $93.33 / $257.04
| Professional | | $52.48 | $93.33 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $30.90 / $72.44
| Professional | 26 | $18.62 | $30.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $64.57 / $199.53
| Professional | TC | $26.92 | $64.57 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $269.15
| Professional | | $85.11 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $58.88 / $95.50
| Professional | 26 | $34.67 | $58.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.98 / $162.18 / $194.98
| Professional | TC | $16.98 | $162.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $144.54
| Professional | | $74.13 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $151.36 / $389.05
| Professional | | $83.18 | $151.36 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $91.20
| Professional | 26 | $25.70 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $61.66 / $120.23 / $281.84
| Professional | TC | $61.66 | $120.23 | $281.84 |