- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $933.25 / $1,047.13
| Professional | | $794.33 | $933.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $338.84
| Professional | 26 | $77.62 | $109.65 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $707.95 / $831.76 / $933.25
| Professional | TC | $707.95 | $831.76 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $724.44 / $1,905.46
| Professional | | $616.60 | $724.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $85.11 / $204.17
| Professional | 26 | $72.44 | $85.11 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $645.65 / $1,698.24
| Professional | TC | $549.54 | $645.65 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,000.00 / $1,819.70 / $1,995.26
| Professional | | $1,000.00 | $1,819.70 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $117.49 / $194.98 / $213.80
| Professional | 26 | $117.49 | $194.98 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $891.25 / $1,621.81 / $1,778.28
| Professional | TC | $891.25 | $1,621.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $812.83 / $1,023.29 / $1,548.82
| Professional | | $812.83 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $114.82 / $154.88
| Professional | 26 | $89.13 | $114.82 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $724.44 / $912.01 / $1,288.25
| Professional | TC | $724.44 | $912.01 | $1,288.25 |