- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $512.86 / $851.14
| Professional | | $389.05 | $512.86 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $48.98 / $107.15
| Professional | 26 | $34.67 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $354.81 / $457.09 / $758.58
| Professional | TC | $354.81 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $724.44
| Professional | | $616.60 | $616.60 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $72.44
| Professional | 26 | $61.66 | $61.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $549.54 / $549.54 / $645.65
| Professional | TC | $549.54 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $398.11 / $776.25
| Professional | | $263.03 | $398.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $95.50
| Professional | 26 | $26.92 | $45.71 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $234.42 / $354.81 / $691.83
| Professional | TC | $234.42 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $446.68 / $645.65
| Professional | | $316.23 | $446.68 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $34.67 / $47.86 / $66.07
| Professional | 26 | $34.67 | $47.86 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $281.84 / $323.59 / $575.44
| Professional | TC | $281.84 | $323.59 | $575.44 |