- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $16.98 / $125.89
| Facility | | $3.72 | $16.98 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $18.62 / $54.95 / $190.55
| Facility | 26 | $18.62 | $54.95 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $44.67 / $64.57
| Professional | | $15.14 | $44.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $16.98 / $44.67 / $125.89
| Professional | 26 | $16.98 | $44.67 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.47 / $7.94 / $30.20
| Facility | | $3.47 | $7.94 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $43.65 / $97.72
| Professional | | $15.85 | $43.65 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.41 / $18.20 / $60.26
| Professional | 26 | $7.41 | $18.20 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $9.55 / $63.10
| Facility | | $3.39 | $9.55 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $10.47 / $63.10 / $346.74
| Facility | 26 | $10.47 | $63.10 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $69.18
| Professional | | $43.65 | $43.65 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $64.57
| Professional | 26 | $40.74 | $40.74 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $3.16 / $16.98
| Facility | | $1.74 | $3.16 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $81.28
| Professional | | $17.38 | $26.92 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $27.54 / $85.11
| Professional | 26 | $17.38 | $27.54 | $85.11 |