- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $147.91 / $537.03
| Professional | | $70.79 | $147.91 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $72.44
| Professional | 26 | $21.88 | $34.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $48.98 / $74.13 / $204.17
| Professional | TC | $48.98 | $74.13 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $138.04 / $346.74
| Professional | | $61.66 | $138.04 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $95.50
| Professional | 26 | $18.62 | $35.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $100.00 / $245.47
| Professional | TC | $42.66 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $245.47
| Professional | | $79.43 | $128.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $74.13
| Professional | 26 | $22.91 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $93.33 / $173.78
| Professional | TC | $56.23 | $93.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $478.63
| Professional | | $79.43 | $128.82 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $112.20
| Professional | 26 | $22.91 | $38.02 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $56.23 / $91.20 / $371.54
| Professional | TC | $56.23 | $91.20 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $112.20 / $245.47
| Professional | | $52.48 | $112.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $30.20 / $69.18
| Professional | 26 | $15.14 | $30.20 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $38.02 / $77.62 / $177.83
| Professional | TC | $38.02 | $77.62 | $177.83 |