- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $851.14 / $851.14
| Professional | | $794.33 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $239.88 / $263.03 / $275.42
| Professional | 26 | $239.88 | $263.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $524.81 / $602.56 / $602.56
| Professional | TC | $524.81 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $891.25 / $1,071.52
| Professional | | $724.44 | $891.25 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $204.17 / $257.04 / $309.03
| Professional | 26 | $204.17 | $257.04 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $645.65 / $776.25
| Professional | TC | $512.86 | $645.65 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $549.54 / $707.95
| Professional | | $407.38 | $549.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $144.54 / $194.98 / $288.40
| Professional | 26 | $144.54 | $194.98 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $263.03 / $457.09 / $562.34
| Professional | TC | $263.03 | $457.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $707.95 / $1,071.52
| Professional | | $363.08 | $707.95 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $204.17 / $389.05
| Professional | 26 | $138.04 | $204.17 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $229.09 / $478.63 / $741.31
| Professional | TC | $229.09 | $478.63 | $741.31 |