- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $141.25 / $177.83
| Professional | | $63.10 | $141.25 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $134.90
| Professional | 26 | $33.88 | $51.29 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $100.00 / $162.18
| Professional | TC | $48.98 | $100.00 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $213.80
| Professional | | $60.26 | $60.26 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $22.39 / $83.18
| Professional | 26 | $21.38 | $22.39 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.90 / $39.81 / $128.82
| Professional | TC | $38.90 | $39.81 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.84 / $30.90 / $57.54
| Facility | 26 | $28.84 | $30.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $79.43 / $194.98
| Professional | | $56.23 | $79.43 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $69.18
| Professional | 26 | $20.42 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $125.89
| Professional | TC | $35.48 | $50.12 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $147.91 / $186.21
| Professional | | $37.15 | $147.91 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $52.48 / $66.07
| Professional | 26 | $13.18 | $52.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $95.50 / $120.23
| Professional | TC | $23.44 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $114.82 / $194.98
| Professional | | $107.15 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $40.74 / $75.86
| Professional | 26 | $39.81 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $74.13 / $123.03
| Professional | TC | $67.61 | $74.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $316.23
| Professional | | $77.62 | $109.65 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $128.82
| Professional | 26 | $28.18 | $35.48 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $50.12 / $58.88 / $186.21
| Professional | TC | $50.12 | $58.88 | $186.21 |