- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $104.71 / $229.09
| Professional | | $72.44 | $104.71 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $263.03 / $549.54
| Professional | 26 | $33.88 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $40.74 / $67.61 / $112.20
| Professional | TC | $40.74 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $181.97 / $229.09
| Professional | | $45.71 | $181.97 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $57.54 / $75.86
| Professional | 26 | $15.49 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $30.90 / $114.82 / $154.88
| Professional | TC | $30.90 | $114.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $120.23 / $239.88
| Professional | | $79.43 | $120.23 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $39.81 / $93.33
| Professional | 26 | $26.30 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $147.91
| Professional | TC | $47.86 | $77.62 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $181.97 / $338.84
| Professional | | $147.91 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $109.65
| Professional | 26 | $47.86 | $58.88 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $123.03 / $229.09
| Professional | TC | $100.00 | $123.03 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $154.88 / $275.42
| Professional | | $75.86 | $154.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $53.70 / $123.03
| Professional | 26 | $33.88 | $53.70 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $100.00 / $181.97
| Professional | TC | $41.69 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $177.83 / $338.84
| Professional | | $107.15 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $109.65
| Professional | 26 | $35.48 | $58.88 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $229.09
| Professional | TC | $66.07 | $114.82 | $229.09 |