- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $39.81 / $436.52
| Facility | | $10.00 | $39.81 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.61 / $6.61 / $6.61
| Facility | 26 | $6.61 | $6.61 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $14.79 / $38.90
| Professional | | $9.77 | $14.79 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $8.91 / $25.12
| Professional | 26 | $6.03 | $8.91 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $11.48 / $11.48 / $29.51
| Professional | 50 | $11.48 | $11.48 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $11.48
| Professional | TC | $2.00 | $3.98 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $11.22 / $13.49
| Professional | | $7.41 | $11.22 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $7.41 / $9.33
| Professional | 26 | $7.41 | $7.41 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $4.79
| Professional | TC | $3.80 | $3.80 | $4.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $17.78
| Facility | | $10.72 | $10.72 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $12.30
| Facility | 26 | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $14.13 / $26.30
| Professional | | $9.12 | $14.13 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.03 / $9.77 / $17.38
| Professional | 26 | $6.03 | $9.77 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.82 / $4.57 / $8.91
| Professional | TC | $2.82 | $4.57 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $14.13 / $20.89
| Professional | | $12.30 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $9.33 / $13.49
| Professional | 26 | $7.94 | $9.33 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $4.37 / $5.01 / $7.08
| Professional | TC | $4.37 | $5.01 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $8.71 / $15.49
| Facility | | $2.24 | $8.71 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $13.49 / $26.30
| Professional | | $9.77 | $13.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $9.12 / $17.38
| Professional | 26 | $6.76 | $9.12 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $2.57 / $4.47 / $8.91
| Professional | TC | $2.57 | $4.47 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $15.14 / $17.78
| Professional | | $11.75 | $15.14 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.76 / $9.77 / $11.48
| Professional | 26 | $7.76 | $9.77 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.89 / $5.37 / $6.17
| Professional | TC | $3.89 | $5.37 | $6.17 |