- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $831.76
| Professional | | $346.74 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $112.20 / $263.03
| Professional | 26 | $77.62 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $354.81 / $660.69
| Professional | TC | $263.03 | $354.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $691.83 / $691.83
| Professional | | $131.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $158.49
| Facility | 26 | $131.83 | $131.83 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $588.84 / $1,949.84
| Professional | | $263.03 | $588.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $85.11 / $120.23 / $354.81
| Professional | 26 | $85.11 | $120.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $478.63 / $1,584.89
| Professional | TC | $177.83 | $478.63 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $758.58 / $851.14
| Professional | | $676.08 | $758.58 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $158.49
| Facility | 26 | $131.83 | $131.83 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $891.25 / $1,148.15
| Professional | | $446.68 | $891.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $120.23 / $190.55
| Professional | 26 | $87.10 | $120.23 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $295.12 / $489.78 / $758.58
| Professional | TC | $295.12 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $323.59 / $660.69 / $794.33
| Professional | | $323.59 | $660.69 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $93.33 / $144.54 / $173.78
| Professional | 26 | $93.33 | $144.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $512.86 / $616.60
| Professional | TC | $229.09 | $512.86 | $616.60 |