- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $398.11 / $724.44
| Professional | | $295.12 | $398.11 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $181.97
| Professional | 26 | $51.29 | $67.61 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $239.88 / $338.84 / $616.60
| Professional | TC | $239.88 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $616.60 / $616.60
| Professional | | $87.10 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $104.71
| Facility | 26 | $87.10 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $524.81 / $1,698.24
| Professional | | $194.98 | $524.81 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $234.42
| Professional | 26 | $54.95 | $75.86 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $138.04 / $457.09 / $1,479.11
| Professional | TC | $138.04 | $457.09 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $676.08 / $758.58
| Professional | | $562.34 | $676.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $104.71
| Facility | 26 | $87.10 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $398.11 / $794.33 / $1,023.29
| Professional | | $398.11 | $794.33 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $123.03
| Professional | 26 | $54.95 | $79.43 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $288.40 / $467.74 / $724.44
| Professional | TC | $288.40 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $562.34 / $707.95
| Professional | | $239.88 | $562.34 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $112.20
| Professional | 26 | $58.88 | $93.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $478.63 / $588.84
| Professional | TC | $181.97 | $478.63 | $588.84 |