- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $537.03 / $2,041.74
| Professional | | $371.54 | $537.03 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $107.15 / $194.98 / $575.44
| Professional | 26 | $107.15 | $194.98 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $363.08 / $741.31
| Professional | TC | $257.04 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $354.81 / $354.81
| Professional | | $117.49 | $354.81 | $354.81 |
- 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
- $275.42 / $549.54 / $1,071.52
| Professional | | $275.42 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $151.36 / $323.59
| Professional | 26 | $66.07 | $151.36 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $758.58
| Professional | TC | $208.93 | $389.05 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $630.96 / $812.83
| Professional | | $602.56 | $630.96 | $812.83 |
- 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
- $524.81 / $794.33 / $977.24
| Professional | | $524.81 | $794.33 | $977.24 |
- 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
- $269.15 / $389.05 / $562.34
| Professional | TC | $269.15 | $389.05 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $630.96 / $1,174.90
| Professional | | $346.74 | $630.96 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $100.00 / $208.93
| Professional | 26 | $74.13 | $100.00 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $245.47 / $457.09 / $1,023.29
| Professional | TC | $245.47 | $457.09 | $1,023.29 |