- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $60.26 / $239.88
| Facility | | $13.49 | $60.26 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.47 / $6.31 / $17.78
| Facility | 26 | $3.47 | $6.31 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $17.78 / $47.86
| Professional | | $10.00 | $17.78 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.92 / $18.62
| Professional | 26 | $3.02 | $6.92 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $11.48 / $29.51
| Professional | TC | $7.08 | $11.48 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Facility | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $19.50 / $45.71
| Professional | | $10.47 | $19.50 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.86 / $6.61 / $12.59
| Professional | 26 | $1.86 | $6.61 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $3.47 / $12.88 / $33.11
| Professional | TC | $3.47 | $12.88 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $29.51 / $120.23
| Facility | | $11.22 | $29.51 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.05 / $5.62 / $14.45
| Facility | 26 | $1.05 | $5.62 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $15.14 / $36.31
| Professional | | $7.59 | $15.14 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $4.27 / $9.33
| Professional | 26 | $2.09 | $4.27 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.37 / $11.22 / $27.54
| Professional | TC | $5.37 | $11.22 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.94 / $22.39
| Facility | | $3.02 | $7.94 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $16.60 / $44.67
| Professional | | $9.33 | $16.60 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.57 / $4.68 / $19.05
| Professional | 26 | $2.57 | $4.68 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.46 / $11.75 / $25.12
| Professional | TC | $6.46 | $11.75 | $25.12 |