- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $79.43 / $177.83
| Professional | | $66.07 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $114.82
| Professional | 26 | $33.88 | $44.67 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $38.02 / $64.57
| Professional | TC | $22.39 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $91.20 / $162.18
| Professional | | $51.29 | $91.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $93.33
| Professional | 26 | $35.48 | $48.98 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $31.62 / $40.74 / $72.44
| Professional | TC | $31.62 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $162.18
| Professional | | $74.13 | $100.00 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $79.43
| Professional | 26 | $43.65 | $53.70 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $27.54 / $46.77 / $81.28
| Professional | TC | $27.54 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $114.82 / $213.80
| Professional | | $83.18 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $42.66 / $57.54 / $100.00
| Professional | 26 | $42.66 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $100.00
| Professional | TC | $41.69 | $57.54 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $85.11 / $134.90
| Professional | | $66.07 | $85.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $46.77 / $75.86
| Professional | 26 | $38.90 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $36.31 / $64.57
| Professional | TC | $22.39 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $93.33 / $147.91
| Professional | | $74.13 | $93.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $41.69 / $57.54 / $77.62
| Professional | 26 | $41.69 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $74.13
| Professional | TC | $26.30 | $44.67 | $74.13 |