- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $446.68 / $1,023.29
| Professional | | $338.84 | $446.68 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $67.61 / $177.83
| Professional | 26 | $52.48 | $67.61 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $309.03 / $380.19 / $776.25
| Professional | TC | $309.03 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $478.63 / $575.44
| Professional | | $56.23 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $56.23 / $63.10 / $74.13
| Professional | 26 | $56.23 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $645.65
| Professional | TC | $467.74 | $467.74 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $630.96 / $1,096.48
| Professional | | $407.38 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $83.18 / $144.54
| Professional | 26 | $52.48 | $83.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $363.08 / $549.54 / $1,023.29
| Professional | TC | $363.08 | $549.54 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $562.34 / $741.31
| Professional | | $389.05 | $562.34 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $89.13
| Professional | 26 | $44.67 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $338.84 / $501.19 / $660.69
| Professional | TC | $338.84 | $501.19 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $977.24
| Professional | | $354.81 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $51.29 / $77.62 / $134.90
| Professional | 26 | $51.29 | $77.62 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $831.76
| Professional | TC | $302.00 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $512.86 / $758.58
| Professional | | $416.87 | $512.86 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $52.48 / $60.26 / $87.10
| Professional | 26 | $52.48 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $371.54 / $457.09 / $676.08
| Professional | TC | $371.54 | $457.09 | $676.08 |