- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $54.95 / $177.83
| Professional | | $42.66 | $54.95 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $79.43
| Professional | 26 | $22.91 | $28.18 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $70.79
| Professional | TC | $15.85 | $23.99 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $37.15 / $69.18
| Professional | | $21.88 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $57.54
| Professional | 26 | $25.70 | $25.70 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $26.30
| Professional | TC | $11.75 | $11.75 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $63.10
| Professional | | $28.18 | $34.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $35.48 / $37.15
| Professional | 26 | $34.67 | $35.48 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $26.92 / $27.54 / $28.84
| Professional | TC | $26.92 | $27.54 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $51.29 / $60.26
| Professional | | $46.77 | $51.29 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $39.81
| Professional | 26 | $30.90 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $17.38 / $20.42
| Professional | TC | $15.85 | $17.38 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $77.62 / $263.03
| Professional | | $42.66 | $77.62 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $87.10
| Professional | 26 | $32.36 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $100.00
| Professional | TC | $18.62 | $35.48 | $100.00 |