- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $389.05 / $1,148.15
| Professional | | $269.15 | $389.05 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $45.71 / $77.62 / $199.53
| Professional | 26 | $45.71 | $77.62 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $223.87 / $380.19 / $489.78
| Professional | TC | $223.87 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $245.47 / $524.81
| Professional | | $63.10 | $245.47 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $199.53 / $660.69
| Professional | | $91.20 | $199.53 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $29.51 / $70.79 / $104.71
| Professional | 26 | $29.51 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $60.26 / $165.96 / $549.54
| Professional | TC | $60.26 | $165.96 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $407.38 / $2,570.40
| Professional | | $134.90 | $407.38 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $39.81 / $67.61 / $398.11
| Professional | 26 | $39.81 | $67.61 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $93.33 / $234.42 / $2,187.76
| Professional | TC | $93.33 | $234.42 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $660.69
| Professional | | $208.93 | $245.47 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $81.28 / $316.23
| Professional | 26 | $40.74 | $81.28 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $141.25 / $208.93 / $549.54
| Professional | TC | $141.25 | $208.93 | $549.54 |