- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $117.49 / $151.36
| Professional | | $87.10 | $117.49 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $18.20
| Professional | 26 | $12.02 | $14.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $134.90
| Professional | TC | $72.44 | $102.33 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $302.00 / $338.84
| Professional | | $223.87 | $302.00 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $38.02
| Professional | 26 | $25.12 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $199.53 / $269.15 / $302.00
| Professional | TC | $199.53 | $269.15 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $457.09
| Professional | | $117.49 | $263.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $27.54 / $48.98
| Professional | 26 | $12.59 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $107.15 / $234.42 / $407.38
| Professional | TC | $107.15 | $234.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $147.91 / $794.33
| Professional | | $93.33 | $147.91 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $20.89 / $134.90
| Professional | 26 | $13.18 | $20.89 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $79.43 / $128.82 / $707.95
| Professional | TC | $79.43 | $128.82 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $281.84
| Professional | | $97.72 | $165.96 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $22.39 / $32.36
| Professional | 26 | $12.59 | $22.39 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $245.47
| Professional | TC | $83.18 | $141.25 | $245.47 |