- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $229.09
| Professional | | $70.79 | $97.72 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $83.18
| Professional | 26 | $21.88 | $30.20 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $47.86 / $66.07 / $147.91
| Professional | TC | $47.86 | $66.07 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $154.88 / $331.13
| Professional | | $100.00 | $154.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $97.72
| Professional | 26 | $23.99 | $39.81 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $245.47
| Professional | TC | $69.18 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $120.23 / $407.38
| Professional | | $52.48 | $120.23 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $117.49
| Professional | 26 | $16.22 | $30.90 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.88 / $81.28 / $288.40
| Professional | TC | $33.88 | $81.28 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $158.49 / $851.14
| Professional | | $95.50 | $158.49 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $46.77 / $263.03
| Professional | 26 | $28.18 | $46.77 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $549.54
| Professional | TC | $67.61 | $112.20 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $97.72 / $194.98
| Professional | | $33.11 | $97.72 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $120.23 / $323.59
| Professional | | $66.07 | $120.23 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.38 / $36.31 / $91.20
| Professional | 26 | $21.38 | $36.31 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $79.43 / $223.87
| Professional | TC | $45.71 | $79.43 | $223.87 |