- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $194.98
| Facility | | $46.77 | $46.77 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | 26 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $44.67
| Professional | | $10.96 | $15.14 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $6.31 / $21.88
| Professional | 26 | $3.02 | $6.31 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.94 / $10.23 / $29.51
| Professional | TC | $7.94 | $10.23 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $2.24 / $4.79
| Professional | 26 | $1.95 | $2.24 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $15.49 / $26.30
| Professional | | $5.13 | $15.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $12.59 / $28.18
| Professional | | $7.59 | $12.59 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $2.09 / $2.63 / $7.59
| Professional | 26 | $2.09 | $2.63 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $5.50 / $8.71 / $20.89
| Professional | TC | $5.50 | $8.71 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $83.18
| Professional | | $18.20 | $28.84 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.90 / $7.59 / $54.95
| Professional | 26 | $4.90 | $7.59 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $12.30 / $19.50 / $83.18
| Professional | TC | $12.30 | $19.50 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $21.88 / $75.86
| Professional | | $10.23 | $21.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $5.13 / $22.91
| Professional | 26 | $3.09 | $5.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $7.08 / $12.30 / $25.12
| Professional | TC | $7.08 | $12.30 | $25.12 |