- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $89.13 / $251.19
| Facility | | $28.84 | $89.13 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $40.74 / $117.49
| Professional | | $22.91 | $40.74 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $14.45 / $79.43
| Professional | 26 | $5.01 | $14.45 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $28.84 / $67.61
| Professional | TC | $15.85 | $28.84 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.39 / $4.90 / $8.71
| Professional | 26 | $3.39 | $4.90 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $53.70 / $54.95
| Professional | | $39.81 | $53.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.72 / $10.72 / $14.45
| Professional | 26 | $10.72 | $10.72 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $57.54
| Professional | TC | $42.66 | $42.66 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $30.20 / $79.43
| Facility | | $6.31 | $30.20 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $30.20 / $61.66
| Professional | | $7.41 | $30.20 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $20.89 / $77.62
| Professional | | $14.45 | $20.89 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $4.07 / $28.18
| Professional | 26 | $3.09 | $4.07 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $44.67
| Professional | TC | $10.47 | $14.13 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $107.15 / $251.19
| Facility | | $50.12 | $107.15 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $46.77 / $85.11
| Professional | | $27.54 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.75 / $8.91 / $46.77
| Professional | 26 | $5.75 | $8.91 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $67.61
| Professional | TC | $20.89 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $18.20 / $56.23
| Professional | | $14.45 | $18.20 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $3.09 / $3.63 / $19.05
| Professional | 26 | $3.09 | $3.63 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $10.47 / $13.49 / $46.77
| Professional | TC | $10.47 | $13.49 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $93.33
| Professional | | $19.95 | $33.11 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $4.27 / $7.24 / $52.48
| Professional | 26 | $4.27 | $7.24 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $77.62
| Professional | TC | $15.85 | $26.92 | $77.62 |