- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $295.12 / $436.52
| Professional | | $208.93 | $295.12 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $60.26 / $104.71 / $134.90
| Professional | 26 | $60.26 | $104.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $151.36 / $181.97 / $281.84
| Professional | TC | $151.36 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $316.23
| Professional | | $269.15 | $269.15 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $436.52 / $812.83
| Professional | | $251.19 | $436.52 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $63.10 / $123.03 / $218.78
| Professional | 26 | $63.10 | $123.03 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $186.21 / $257.04 / $389.05
| Professional | TC | $186.21 | $257.04 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $239.88 / $812.83
| Professional | | $229.09 | $239.88 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $67.61 / $218.78
| Professional | 26 | $61.66 | $67.61 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $165.96 / $173.78 / $275.42
| Professional | TC | $165.96 | $173.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $562.34
| Professional | | $239.88 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $144.54
| Professional | 26 | $64.57 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $218.78 / $398.11
| Professional | TC | $173.78 | $218.78 | $398.11 |