- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $331.13 / $616.60
| Professional | | $295.12 | $331.13 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $33.88 / $34.67 / $74.13
| Professional | 26 | $33.88 | $34.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $257.04 / $263.03 / $537.03
| Professional | TC | $257.04 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $407.38 / $562.34
| Professional | | $46.77 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $281.84 / $724.44
| Professional | | $177.83 | $281.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $21.88 / $52.48 / $79.43
| Professional | 26 | $21.88 | $52.48 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $251.19 / $660.69
| Professional | TC | $151.36 | $251.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $467.74 / $2,754.23
| Professional | | $257.04 | $467.74 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $51.29 / $309.03
| Professional | 26 | $30.20 | $51.29 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $398.11 / $2,454.71
| Professional | TC | $229.09 | $398.11 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $741.31
| Professional | | $269.15 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.20 / $48.98 / $81.28
| Professional | 26 | $30.20 | $48.98 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $660.69
| Professional | TC | $239.88 | $338.84 | $660.69 |