- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $501.19 / $954.99
| Professional | | $354.81 | $501.19 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $42.66 / $114.82
| Professional | 26 | $36.31 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $457.09 / $831.76
| Professional | TC | $316.23 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $549.54
| Professional | | $467.74 | $467.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $66.07
| Professional | 26 | $44.67 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $478.63
| Professional | TC | $416.87 | $416.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $851.14 / $1,047.13
| Professional | | $354.81 | $851.14 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $36.31 / $89.13 / $114.82
| Professional | 26 | $36.31 | $89.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $316.23 / $758.58 / $954.99
| Professional | TC | $316.23 | $758.58 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $2,691.53 / $3,090.30
| Professional | | $812.83 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $251.19 / $309.03
| Professional | 26 | $77.62 | $251.19 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $741.31 / $2,454.71 / $2,754.23
| Professional | TC | $741.31 | $2,454.71 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $549.54
| Professional | | $467.74 | $467.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $66.07
| Professional | 26 | $44.67 | $44.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $478.63
| Professional | TC | $416.87 | $416.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $870.96 / $2,041.74
| Professional | | $588.84 | $870.96 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $87.10 / $251.19
| Professional | 26 | $60.26 | $87.10 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $776.25 / $1,778.28
| Professional | TC | $524.81 | $776.25 | $1,778.28 |