- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $107.15 / $144.54
| Professional | | $87.10 | $107.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $79.43 / $95.50
| Professional | 26 | $67.61 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $117.49
| Professional | 52 | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $37.15
| Professional | TC | $19.05 | $30.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $97.72 / $104.71
| Professional | | $87.10 | $97.72 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $190.55
| Professional | | $100.00 | $162.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $93.33 / $147.91
| Professional | 26 | $72.44 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $85.11
| Professional | TC | $26.92 | $40.74 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $109.65 / $173.78
| Professional | | $81.28 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $134.90
| Professional | 26 | $66.07 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.22 / $25.12 / $50.12
| Professional | TC | $16.22 | $25.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $134.90
| Professional | | $81.28 | $95.50 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $75.86 / $107.15
| Professional | 26 | $63.10 | $75.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.79 / $21.88 / $31.62
| Professional | TC | $14.79 | $21.88 | $31.62 |