- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $549.54 / $2,041.74
| Professional | | $416.87 | $549.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $199.53
| Professional | 26 | $38.02 | $66.07 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $436.52 / $870.96
| Professional | TC | $371.54 | $436.52 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $630.96
| Professional | | $64.57 | $64.57 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $81.28
| Facility | 26 | $64.57 | $64.57 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $630.96 / $1,230.27
| Professional | | $338.84 | $630.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $35.48 / $64.57 / $123.03
| Professional | 26 | $35.48 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $562.34 / $1,096.48
| Professional | TC | $302.00 | $562.34 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $741.31 / $1,445.44
| Professional | | $676.08 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $81.28
| Facility | 26 | $64.57 | $64.57 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $616.60 / $891.25
| Professional | | $436.52 | $616.60 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $89.13
| Professional | 26 | $43.65 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $389.05 / $549.54 / $794.33
| Professional | TC | $389.05 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $416.87 / $794.33
| Professional | | $389.05 | $416.87 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $77.62
| Professional | 26 | $38.90 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $346.74 / $371.54 / $724.44
| Professional | TC | $346.74 | $371.54 | $724.44 |