- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $190.55 / $263.03
| Professional | | $169.82 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $81.28
| Professional | 26 | $47.86 | $56.23 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $120.23 / $131.83 / $181.97
| Professional | TC | $120.23 | $131.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $1,698.24
| Professional | | $436.52 | $436.52 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $1,698.24
| Professional | | $245.47 | $489.78 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $91.20 / $263.03
| Professional | 26 | $60.26 | $91.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $169.82 / $316.23 / $478.63
| Professional | TC | $169.82 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $380.19 / $562.34
| Professional | | $213.80 | $380.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $61.66 / $91.20
| Professional | 26 | $60.26 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $147.91 / $316.23 / $467.74
| Professional | TC | $147.91 | $316.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $416.87 / $602.56
| Professional | | $251.19 | $416.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $75.86 / $97.72
| Professional | 26 | $40.74 | $75.86 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $208.93 / $346.74 / $501.19
| Professional | TC | $208.93 | $346.74 | $501.19 |