- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $363.08 / $741.31
| Professional | | $269.15 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $457.09
| Professional | 26 | $89.13 | $162.18 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $251.19 / $467.74
| Professional | TC | $181.97 | $251.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $295.12
| Professional | | $218.78 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $154.88
| Professional | 26 | $70.79 | $70.79 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $147.91
| Professional | TC | $141.25 | $141.25 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $676.08 / $1,412.54
| Professional | | $269.15 | $676.08 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $275.42 / $2,089.30
| Professional | 26 | $89.13 | $275.42 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $436.52 / $691.83
| Professional | TC | $181.97 | $436.52 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $1,905.46 / $2,344.23
| Professional | | $575.44 | $1,905.46 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $194.98 / $630.96 / $758.58
| Professional | 26 | $194.98 | $630.96 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $380.19 / $1,202.26 / $1,584.89
| Professional | TC | $380.19 | $1,202.26 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $295.12
| Professional | | $218.78 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $154.88
| Professional | 26 | $70.79 | $70.79 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $147.91
| Professional | TC | $141.25 | $141.25 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $660.69 / $1,548.82
| Professional | | $426.58 | $660.69 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $151.36 / $213.80 / $630.96
| Professional | 26 | $151.36 | $213.80 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $446.68 / $912.01
| Professional | TC | $275.42 | $446.68 | $912.01 |