- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $478.63 / $1,096.48
| Professional | | $407.38 | $478.63 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.02 / $47.86 / $107.15
| Professional | 26 | $38.02 | $47.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $416.87 / $977.24
| Professional | TC | $363.08 | $416.87 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $724.44
| Professional | | $478.63 | $478.63 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $77.62
| Professional | 26 | $52.48 | $52.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $426.58 / $426.58 / $645.65
| Professional | TC | $426.58 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $512.86 / $954.99
| Professional | | $288.40 | $512.86 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $30.90 / $56.23 / $95.50
| Professional | 26 | $30.90 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $251.19 / $446.68 / $831.76
| Professional | TC | $251.19 | $446.68 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $660.69
| Professional | | $302.00 | $501.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $74.13
| Professional | 26 | $32.36 | $50.12 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $269.15 / $446.68 / $575.44
| Professional | TC | $269.15 | $446.68 | $575.44 |