- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $602.56 / $2,137.96
| Professional | | $363.08 | $602.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $102.33 / $213.80 / $616.60
| Professional | 26 | $102.33 | $213.80 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $380.19 / $724.44
| Professional | TC | $251.19 | $380.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $524.81 / $524.81
| Professional | | $169.82 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $208.93
| Facility | 26 | $169.82 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $1,023.29
| Professional | | $501.19 | $630.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $75.86 / $169.82 / $302.00
| Professional | 26 | $75.86 | $169.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $467.74 / $851.14
| Professional | TC | $234.42 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $602.56 / $1,023.29
| Professional | | $562.34 | $602.56 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $208.93
| Facility | 26 | $169.82 | $169.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $758.58 / $933.25
| Professional | | $501.19 | $758.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $169.82 / $251.19
| Professional | 26 | $112.20 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $371.54 / $812.83
| Professional | TC | $239.88 | $371.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $524.81 / $977.24
| Professional | | $316.23 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $100.00 / $112.20 / $251.19
| Professional | 26 | $100.00 | $112.20 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $218.78 / $389.05 / $776.25
| Professional | TC | $218.78 | $389.05 | $776.25 |