- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $1,288.25
| Professional | | $245.47 | $245.47 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $58.88 / $162.18
| Professional | 26 | $39.81 | $58.88 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $204.17 / $204.17 / $741.31
| Professional | TC | $204.17 | $204.17 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 26 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $588.84 / $602.56
| Professional | | $398.11 | $588.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $97.72
| Professional | 26 | $66.07 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $501.19
| Professional | TC | $338.84 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $676.08 / $912.01
| Professional | | $588.84 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $95.50 / $120.23 / $144.54
| Professional | 26 | $95.50 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $562.34 / $758.58
| Professional | TC | $501.19 | $562.34 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $380.19 / $2,570.40
| Professional | | $199.53 | $380.19 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $66.07 / $398.11
| Professional | 26 | $61.66 | $66.07 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $309.03 / $2,187.76
| Professional | TC | $134.90 | $309.03 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $660.69 / $676.08 / $933.25
| Professional | | $660.69 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $109.65 / $120.23 / $158.49
| Professional | 26 | $109.65 | $120.23 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $562.34 / $776.25
| Professional | TC | $549.54 | $562.34 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $870.96 / $933.25
| Professional | | $870.96 | $870.96 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $144.54 / $158.49
| Professional | 26 | $138.04 | $144.54 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $776.25
| Professional | TC | $724.44 | $724.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $380.19 / $741.31
| Professional | | $199.53 | $380.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $57.54 / $66.07 / $158.49
| Professional | 26 | $57.54 | $66.07 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $134.90 / $309.03 / $616.60
| Professional | TC | $134.90 | $309.03 | $616.60 |