- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $851.14 / $1,258.93
| Professional | | $549.54 | $851.14 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $112.20 / $234.42 / $549.54
| Professional | 26 | $112.20 | $234.42 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $275.42
| Professional | 52 | $269.15 | $269.15 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $446.68 / $630.96 / $1,071.52
| Professional | TC | $446.68 | $630.96 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $1,023.29
| Professional | | $524.81 | $691.83 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $125.89 / $190.55
| Professional | 26 | $89.13 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $398.11 / $524.81 / $812.83
| Professional | TC | $398.11 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $630.96 / $912.01 / $1,288.25
| Professional | | $630.96 | $912.01 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $120.23 / $165.96 / $251.19
| Professional | 26 | $120.23 | $165.96 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $512.86 / $741.31 / $1,047.13
| Professional | TC | $512.86 | $741.31 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $562.34 / $851.14 / $1,258.93
| Professional | | $562.34 | $851.14 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $125.89 / $173.78 / $251.19
| Professional | 26 | $125.89 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $501.19 / $707.95 / $1,000.00
| Professional | TC | $501.19 | $707.95 | $1,000.00 |