- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $89.13 / $407.38
| Facility | | $26.92 | $89.13 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.50 / $9.77 / $27.54
| Facility | 26 | $5.50 | $9.77 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $42.66 / $114.82
| Professional | | $20.89 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $14.45 / $45.71
| Professional | 26 | $5.01 | $14.45 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $69.18
| Professional | TC | $15.85 | $26.30 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $93.33
| Professional | | $22.39 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.02 / $10.23 / $20.42
| Professional | 26 | $3.02 | $10.23 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $29.51 / $72.44
| Professional | TC | $10.47 | $29.51 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $64.57 / $251.19
| Facility | | $22.91 | $64.57 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.62 / $8.71 / $22.91
| Facility | 26 | $1.62 | $8.71 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $30.90 / $74.13
| Professional | | $15.14 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.24 / $6.61 / $14.79
| Professional | 26 | $3.24 | $6.61 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $11.75 / $24.55 / $61.66
| Professional | TC | $11.75 | $24.55 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $15.14 / $54.95
| Facility | | $4.68 | $15.14 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $33.11 / $87.10
| Professional | | $18.20 | $33.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.98 / $7.24 / $31.62
| Professional | 26 | $3.98 | $7.24 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $14.13 / $26.30 / $66.07
| Professional | TC | $14.13 | $26.30 | $66.07 |