- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $363.08 / $1,148.15
| Professional | | $281.84 | $363.08 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $407.38 / $831.76
| Professional | 26 | $112.20 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $251.19 / $691.83
| Professional | TC | $173.78 | $251.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $446.68
| Professional | 26 | $67.61 | $67.61 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $691.83 / $933.25
| Professional | | $162.18 | $691.83 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $229.09 / $309.03
| Professional | 26 | $61.66 | $229.09 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $102.33 / $457.09 / $616.60
| Professional | TC | $102.33 | $457.09 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $436.52 / $1,230.27
| Professional | | $213.80 | $436.52 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $147.91 / $389.05
| Professional | 26 | $67.61 | $147.91 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $123.03 / $269.15 / $831.76
| Professional | TC | $123.03 | $269.15 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $741.31 / $1,288.25
| Professional | | $478.63 | $741.31 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $154.88 / $239.88 / $426.58
| Professional | 26 | $154.88 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $323.59 / $501.19 / $870.96
| Professional | TC | $323.59 | $501.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $549.54 / $1,479.11
| Professional | | $426.58 | $549.54 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $173.78 / $380.19
| Professional | 26 | $89.13 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $275.42 / $371.54 / $776.25
| Professional | TC | $275.42 | $371.54 | $776.25 |