- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $61.66 / $346.74
| Facility | | $10.23 | $61.66 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $12.59
| Facility | 26 | $7.08 | $7.08 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $15.14 / $35.48
| Professional | | $9.55 | $15.14 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $7.94 / $16.98
| Professional | 26 | $6.03 | $7.94 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | 50 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.29 / $3.72 / $7.08
| Professional | TC | $2.29 | $3.72 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.23 / $14.79
| Professional | | $8.13 | $10.23 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $10.96
| Professional | 26 | $10.23 | $10.23 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $346.74 / $346.74
| Facility | | $4.07 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.45 / $22.91
| Professional | | $11.22 | $14.45 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $12.02 / $18.62
| Professional | 26 | $8.71 | $12.02 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $34.67
| Professional | 50 | $16.98 | $21.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.57 / $3.31 / $4.57
| Professional | TC | $2.57 | $3.31 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $8.91 / $14.13
| Facility | | $3.72 | $8.91 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $8.13 / $13.18
| Professional | | $3.39 | $8.13 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $23.99 / $346.74
| Facility | | $11.75 | $23.99 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $15.14 / $26.92
| Professional | | $10.47 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.92 / $10.72 / $17.78
| Professional | 26 | $6.92 | $10.72 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.63 / $4.37 / $8.91
| Professional | TC | $2.63 | $4.37 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $24.55 / $24.55
| Facility | | $6.46 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.49 / $21.88
| Professional | | $10.47 | $13.49 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $9.55 / $14.45
| Professional | 26 | $7.08 | $9.55 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.95 / $4.07 / $6.92
| Professional | TC | $2.95 | $4.07 | $6.92 |