- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $426.58
| Professional | | $204.17 | $295.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $48.98 / $112.20 / $138.04
| Professional | 26 | $48.98 | $112.20 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $223.87 / $302.00
| Professional | TC | $138.04 | $223.87 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Facility | 26 | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $316.23 / $1,584.89
| Professional | | $269.15 | $316.23 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $234.42
| Professional | 26 | $77.62 | $77.62 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $218.78
| Professional | TC | $181.97 | $181.97 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $436.52 / $741.31
| Professional | | $223.87 | $436.52 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $83.18 / $186.21
| Professional | 26 | $70.79 | $83.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $302.00 / $602.56
| Professional | TC | $141.25 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | 26 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Professional | TC | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $269.15 / $588.84
| Professional | | $190.55 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $151.36
| Professional | 26 | $60.26 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $128.82 / $181.97 / $407.38
| Professional | TC | $128.82 | $181.97 | $407.38 |