- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $602.56 / $2,041.74
| Professional | | $467.74 | $602.56 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $74.13 / $177.83
| Professional | 26 | $64.57 | $74.13 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $478.63 / $912.01
| Professional | TC | $398.11 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $691.83
| Professional | | $104.71 | $104.71 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $128.82
| Facility | 26 | $104.71 | $104.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,348.96
| Professional | | $524.81 | $691.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $46.77 / $79.43 / $199.53
| Professional | 26 | $46.77 | $79.43 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $436.52 / $575.44 / $1,148.15
| Professional | TC | $436.52 | $575.44 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $776.25 / $831.76
| Professional | | $741.31 | $776.25 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $128.82
| Facility | 26 | $104.71 | $104.71 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $660.69 / $954.99
| Professional | | $478.63 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $141.25
| Professional | 26 | $70.79 | $97.72 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $407.38 / $575.44 / $831.76
| Professional | TC | $407.38 | $575.44 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $436.52 / $851.14
| Professional | | $426.58 | $436.52 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $123.03
| Professional | 26 | $61.66 | $64.57 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $380.19 / $741.31
| Professional | TC | $363.08 | $380.19 | $741.31 |