- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $128.82
| Professional | | $50.12 | $75.86 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $33.88 / $199.53
| Professional | 26 | $21.88 | $33.88 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.99 / $39.81 / $52.48
| Professional | TC | $23.99 | $39.81 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $100.00
| Professional | | $41.69 | $41.69 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $100.00
| Facility | | $53.70 | $53.70 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | 26 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $100.00
| Professional | | $57.54 | $89.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $43.65
| Professional | 26 | $22.91 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $58.88
| Professional | TC | $32.36 | $51.29 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $107.15 / $144.54
| Facility | | $104.71 | $107.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $107.15 / $144.54
| Professional | | $104.71 | $107.15 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $104.71
| Facility | | $56.23 | $72.44 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Facility | 26 | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $89.13 / $100.00
| Professional | | $57.54 | $89.13 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $43.65
| Professional | 26 | $22.91 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $58.88
| Professional | TC | $32.36 | $51.29 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $102.33 / $125.89
| Professional | | $81.28 | $102.33 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $52.48
| Professional | 26 | $33.11 | $43.65 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $45.71 / $58.88 / $83.18
| Professional | TC | $45.71 | $58.88 | $83.18 |